With careful consideration of risk factors, the majority of newborns who will need resuscitation can be identified before birth. 6 Several studies have demonstrated that a cesarean section performed under regional anesthesia at 37 to 39 weeks, without antenatally identified risk factors, versus a similar vaginal delivery performed at term, does not increase the risk of the baby requiring endotracheal intubation. Either that person or someone else who is promptly available should have the skills required to perform a complete resuscitation, including endotracheal intubation and administration of medications. This person must be capable of initiating resuscitation, including administration of positive-pressure ventilation and chest compressions. At every delivery there should be at least 1 person whose primary responsibility is the newly born. 4, 5Īnticipation, adequate preparation, accurate evaluation, and prompt initiation of support are critical for successful neonatal resuscitation. When a pulse is detectable, palpation of the umbilical pulse can also provide a rapid estimate of the pulse and is more accurate than palpation at other sites. Assessment of heart rate should be done by intermittently auscultating the precordial pulse. The decision to progress beyond the initial steps is determined by simultaneous assessment of 2 vital characteristics: respirations (apnea, gasping, or labored or unlabored breathing) and heart rate (whether greater than or less than 100 beats per minute). Initial steps in stabilization (provide warmth, clear airway if necessary, dry, stimulate)Īdministration of epinephrine and/or volume expansionĪpproximately 60 seconds (“the Golden Minute”) are allotted for completing the initial steps, reevaluating, and beginning ventilation if required (see Figure). If the answer to any of these assessment questions is “no,” the infant should receive one or more of the following 4 categories of action in sequence: Observation of breathing, activity, and color should be ongoing. The baby should be dried, placed skin-to-skin with the mother, and covered with dry linen to maintain temperature. If the answer to all 3 of these questions is “yes,” the baby does not need resuscitation and should not be separated from the mother. Those newly born infants who do not require resuscitation can generally be identified by a rapid assessment of the following 3 characteristics: 2, 3 Although the vast majority of newly born infants do not require intervention to make the transition from intrauterine to extrauterine life, because of the large total number of births, a sizable number will require some degree of resuscitation. Less than 1% require extensive resuscitative measures. The term newly born is intended to apply specifically to an infant at the time of birth.Īpproximately 10% of newborns require some assistance to begin breathing at birth. For the purposes of these guidelines, the terms newborn and neonate are intended to apply to any infant during the initial hospitalization. Practitioners who resuscitate infants at birth or at any time during the initial hospital admission should consider following these guidelines. They apply primarily to newly born infants undergoing transition from intrauterine to extrauterine life, but the recommendations are also applicable to neonates who have completed perinatal transition and require resuscitation during the first few weeks to months following birth. The following guidelines are an interpretation of the evidence presented in the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations 1). Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).

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