Jay P. Goldsmith

Part 11: Neonatal Resuscitation

Note From the Writing Group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (eg, “Peripartum Suctioning ”). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.

Refining the role of oxygen administration during delivery room resuscitation: What are the future goals?

Oxygen was discovered more than 200 years ago and was thought to be both essential and beneficial for all animal life. Although it is now over 100 years since oxygen was first shown to damage biological tissues exposed to high concentrations, and more than 50 years since it was implicated in the aetiology of retinopathy of prematurity, the use of 100% oxygen was still recommended for the resuscitation of all babies at birth as recently as 2000. However, the 2005 International Liaison Committee on Resuscitation (ILCOR) recommendations allow for the initiation of resuscitation with concentrations of oxygen between 21 and 100%. There are strong arguments in favour of a radical curtailment of the use of oxygen in resuscitation at birth, and for devoting resources to defining the margins of safety for its use in the neonatal period in general.

New ways to ventilate newborns in acute respiratory failure.

Out treatment options for acute neonatal failure have expanded greatly in the last 20 to 30 years. This article reviews patient-triggered ventilation, high frequency ventilation, negative extrathoracic pressure ventilation, nitric oxide therapy, liquid ventilation, extracorporeal membrane oxygenation, and advances in pulmonary function monitoring. The authors present background theories, describe equipment, review clinical strategies, and the results of recent trials.

Quality Improvement in Respiratory Care: Decreasing Bronchopulmonary Dysplasia

Chronic lung disease (CLD) is one of the most common long-term complications in very preterm infants. Bronchopulmonary dysplasia (BPD) is the most common cause of CLD in infancy. Modern neonatal respiratory care has witnessed the emergence of a new BPD that exhibits decreased fibrosis and emphysema, but also decreased alveolar septation, and microvascular development. CLD encompasses the classic and the new BPD, and recognizes that lung injury can occur in term infants who need aggressive ventilatory support and who develop lung injury as a result, and that CLD is a multisystem disease. Controversy exists on whether quality improvement (QI) methods that implement multiple interventions will be effective in limiting pathology with multiple causes. Caution in generalization of QI findings is encouraged. QI methods toward improvement in CLD or any other outcome should be considered as a tool for implementing evidence and studying the effects of change in complex adaptive systems.

The Role of Oxygen in the Delivery Room

As recently as the year 2000, 100% oxygen was recommended to begin resuscitation of depressed newborns in the delivery room. However, the most recent recommendations of the International Liaison Committee on Resuscitation counsel the prudent use of oxygen during resuscitation. In term and preterm infants, oxygen therapy should be guided by pulse oximetry that follows the interquartile range of preductal saturations of healthy term babies after vaginal birth at sea level. This article reviews the literature in this context, which supports the radical but judicious curtailment of the use of oxygen in resuscitation at birth.