Abstract

Although approximately 10% of all newborn infants receive some form of assistance after birth, only 1% of neonates require more advanced measures of life support. Because such situations cannot always be anticipated, paediatricians and neonatologists are frequently unavailable and resuscitation is delegated to the anaesthesiologist. The International Liaison Committee on Resuscitation, the European Resuscitation Council and the American Heart Association have recently updated the guidelines on neonatal resuscitation. The revised guidelines propose a simplified resuscitation algorithm that highlights the central role of respiratory support and promotes an increasing heart rate as the best indicator for effective ventilation. The most striking change in the new guidelines is the recommendation to start resuscitation in term infants with room air rather than 100% oxygen. Continuous pulse oximetry is recommended to monitor both heart rate and an appropriate increase in preductal oxygen saturation. Supplemental oxygen should only be used if, despite effective ventilation, the heart rate does not increase above 100  beats  min(-1), or if oxygenation as indicated by pulse oximetry, remains unacceptably low. This review will focus on foetal physiology and pathophysiological aspects of neonatal adaptation and, thus, attempt to provide a solid basis for understanding the new resuscitation guidelines.

Links

Publisher Full Text

Authors

Berger TM

Institution

Neonatal and Paediatric Intensive Care Unit, Children's Hospital of Lucerne, Lucerne, Switzerland. thomas.berger@luks.ch

Source

European journal of anaesthesiology 29:8 2012 Aug pg 362-70

MeSH

Adaptation, Physiological
Algorithms
Anesthesiology
Cardiopulmonary Resuscitation
Fetus
Heart Rate
Humans
Infant, Newborn
Infant, Newborn, Diseases
Intensive Care, Neonatal
Oximetry
Oxygen Inhalation Therapy
Practice Guidelines as Topic
Respiratory Mechanics
Treatment Outcome

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22717724