Neonatal resuscitation guidelines update: A case-based review

Question 1

What are the key changes based on the 2010 ILCOR and AHA guidelines?

Answer 1

1. Progression to the next step following an initial evaluation is now defined by simultaneous evaluation of HR and respirations.
2. Pulse oximetry should be used for evaluation of oxygenation because colour assessment is unreliable.
3. Room air resuscitation should be started for all term and preterm infants (the initial gas concentration for very preterm infants is unclear).
4. Administration of supplementary oxygen should be regulated by blending air and oxygen, and should be guided by oximetry.
5. Available evidence does not support or refute routine endotracheal suctioning of infants born through MSAF, even when depressed. Until further information is available, endotracheal suctioning of nonvigorous babies should be performed.
6. The chest compression-ventilation ratio remains at 3:1. A higher ratio might be considered if an arrest is of cardiac etiology.
7. Therapeutic hypothermia should be considered within 6 h for infants born at term or late preterm gestation with evolving moderate-severe hypoxic ischemic encephalopathy (with protocol and follow-up through a regional perinatal system).
8. It is appropriate to consider discontinuing resuscitative efforts after there has been no detectable heart rate for 10 min.
9. Cord clamping should be delayed for at least 1 min in babies not requiring resuscitation. There is insufficient evidence to recommend a time for clamping in babies who require resuscitation.
10. Simulation should be used as a teaching methodology in resuscitation education, but the most effective methods of teaching and evaluation remain to be defined.
11. It is reasonable to recommend the use of briefings and debriefings during learning activities both in simulation and in clinical activities