New concepts in neonatal resuscitation

There has been a substantial increase in the number of studies of neonatal resuscitation and it is timely to review the accumulating evidence.

There have been major changes in the way that newly born infants are managed in the delivery room. Colour is no longer recommended as a useful indicator of oxygenation or effectiveness of resuscitation. Pulse oximetry provides rapid, continuous and accurate information on both oxygenation and heart rate. Resuscitation of term infants should begin with air, with the provision of blended oxygen to maintain oxygen saturations similar to those of term infants requiring no resuscitation. Positive end-expiratory pressure during initial ventilation aids lung aeration and establishment of functional residual capacity. Respiratory function monitoring allows operators to identify factors adversely affecting ventilation, including leak around the face mask and airway obstruction. Clamping of the umbilical cord should be delayed for at least 1 min for infants not requiring resuscitation.

The International Liaison Committee on Resuscitation guidelines on the management of newborn infants were updated in 2010 and incorporate much of the newly available evidence. The use of intensive care techniques in the delivery room is promising but requires further evaluation. Monitoring techniques and interventions need to be adapted for use in developing countries.