Neonatal Resuscitation

Abstract

After completing this article, readers should be able to: 1. Describe the individual tasks of a resuscitation team. 2. Delineate the role of continuous heart rate monitoring during resuscitation. 3. List the steps to providing adequate thermoregulation for the extremely low-birthweight infant. 4. Describe the role of T-piece resuscitators. 5. Delineate the role of continuous positive airway pressure (CPAP)/positive end-expiratory pressure (PEEP), carbon dioxide detectors, and pulse oximeters during resuscitation. It may be argued that the most stressful period for both newborns and their caregivers is the first 5 minutes after birth. Most infants adapt well to the transition from intrauterine life, but approximately 10% require some intervention beyond drying, warmth, and minimal airway suction, with 10% to 20% of this group requiring more aggressive interventions to establish and maintain homeostasis. Effectively performed neonatal resuscitation has the potential to decrease infant mortality and morbidity. After birth, the infant must establish effective respirations to achieve successful transition to extrauterine life. Apnea in the immediate newborn period may be an initial sign of asphyxia or may be related to maternal drugs, sepsis, neuromuscular disease, or congenital anomalies. An in utero hypoxic-ischemic injury usually results in the development of primary apnea, which is reversed easily with initial resuscitative measures. More prolonged or severe hypoxia-ischemia leads to secondary apnea that requires more aggressive interventions to reverse. Prolonged apnea after delivery is accompanied by bradycardia and hypotension. The Apgar score may be used to assess the effectiveness of resuscitative efforts. The score was developed in the 1950s by Virginia Apgar as a method of assessing obstetrical and maternal anesthetic management at 1 minute after birth. (1) The 5-minute score is somewhat more predictive of neonatal mortality but has been less useful in predicting long-term neurodevelopmental outcome. (2) In 1985, the American Academy of Pediatrics and the American Heart Association …