Summary of changes since 2005 Guidelines

The following are the main changes that have been made to the guidelines for resuscitation at birth in 2010:

• For uncompromised babies, a delay in cord clamping of at least 1 min from the complete delivery of the infant, is now recommended. As yet there is insufficient evidence to recommend an appropriate time for clamping the cord in babies who are severely compromised at birth.
• For term infants, air should be used for resuscitation at birth. If, despite effective ventilation, oxygenation (ideally guided by oximetry) remains unacceptable, use of a higher concentration of oxygen should be considered.
• Preterm babies less than 32 weeks gestation may not reach the same arterial blood oxygen saturations in air as those achieved by term babies. Therefore blended oxygen and air should be given judiciously and its use guided by pulse oximetry. If a blend of oxygen and air is not available use what is available.
• Preterm babies of less than 28 weeks gestation should be completely covered in a food-grade plastic wrap or bag up to their necks, without drying, immediately after birth. They should then be nursed under a radiant heater and stabilised. They should remain wrapped until their temperature has been checked after admission. For these infants delivery room temperatures should be at least 26 °C.
• The recommended compression:ventilation ratio for CPR remains at 3:1 for newborn resuscitation.
• Attempts to aspirate meconium from the nose and mouth of the unborn baby, while the head is still on the perineum, are not recommended. If presented with a floppy, apnoeic baby born through meconium it is reasonable to rapidly inspect the oropharynx to remove potential obstructions. If appropriate expertise is available, tracheal intubation and suction may be useful. However, if attempted intubation is prolonged or unsuccessful, start mask ventilation, particularly if there is persistent bradycardia.
• If adrenaline (epinephrine) is given then the intravenous route is recommended using a dose of 10–30 μg kg⁻¹. If the tracheal route is used, it is likely that a dose of at least 50–100 μg kg⁻¹ will be needed to achieve a similar effect to 10 μg kg⁻¹ intravenously.
• Detection of exhaled carbon dioxide in addition to clinical assessment is recommended as the most reliable method to confirm placement of a tracheal tube in neonates with spontaneous circulation.
• Newly born infants born at term or near-term with evolving moderate to severe hypoxic–ischemic encephalopathy should, where possible, be offered therapeutic hypothermia. This does not affect immediate resuscitation but is important for post-resuscitation care.

The guidelines that follow do not define the only way that resuscitation at birth should be achieved; they merely represent a widely accepted view of how resuscitation at birth can be carried out both safely and effectively ( Fig. 7.1 ).

Fig. 7.1 Newborn life support algorithm.

References in context

• The guidelines that follow do not define the only way that resuscitation at birth should be achieved; they merely represent a widely accepted view of how resuscitation at birth can be carried out both safely and effectively (Fig. 7.1).
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