Evidence-based Guidelines for Neonatal Resuscitation

Abstract

After completing this article, readers should be able to: 1. Describe the six new guidelines recommendations for neonatal resuscitation. 2. Explain the classes of the new recommendations. Neonatal resuscitation is comprised of a complex series of evaluations of the newborn, decisions on the intervention required, and actions to carry out resuscitation procedures. As attention to the condition of the newborn became more focused in the 1950s and 1960s, well-designed clinical research investigated certain fundamental aspects of care in the delivery room (eg, Apgar scoring and understanding of acute volume expansion after hemorrhage or cord accident). However, much of the sequence of neonatal resuscitation varied substantially between centers and even among individuals within a center. With the advent of the Neonatal Resuscitation Program (NRP) in 1987, a measure of standardization entered the routines of care. The algorithm and procedures within the NRP represented the consensus of expert opinion, based on knowledge of the available resuscitation literature. A mechanism for periodic scientific updates was linked to the Guidelines Conference of the Emergency Cardiovascular Care Committee of the American Heart Association (AHA-ECC). With the 2000 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, the process of neonatal resuscitation has taken a major step toward evidence-based recommendations. Questions submitted to evidence evaluation (Table 1⇓ ) generally represented problematic steps in resuscitation or areas of intense scientific research. Questions were identified through both the Neonatal Resuscitation Steering Committee of the American Academy of Pediatrics and the Pediatric Subcommittee, AHA-ECC. Literature review was directed by at least one expert from the United States and one from outside the United States, representing the International Liaison Committee on Resuscitation. This approach assured better incorporation of the nonEnglish scientific literature and varied viewpoints. As part of the process of classifying the evidence by level (Table 2⇓ ) and measuring …