Resuscitation is derived from the Latin word resuscitare, meaning “to revive.”1 Although the majority of births involve no or little intervention on behalf of the neonate, approximately 10% of newborns need some form of resuscitation, and 1% require extensive maneuvers, such as endotracheal intubation, intravascular access, and drug delivery in the delivery room (DR).2 The transition from fetus to neonate requires a number of physiologic changes, most of which must happen immediately in the seconds and minutes after birth. When these transitions fail to occur, or the fetus has been compromised because of intrinsic disease or utero events, resuscitation is necessary to optimize the chances of a normal outcome.
This chapter focuses on resuscitation of the neonate, not of the fetus or of the mother. Similarly, it does not cover topics more appropriate to stabilization, such as management of glucose homeostasis and electrolyte disorders. Although limited in scope to neonatal resuscitation within the context of the first minutes of life immediately after birth, many of the concepts covered in the chapter are also applicable to neonatal resuscitation in other environments and at later points in the life of the infant. This chapter does not attempt to replicate the definitive resource on neonatal resuscitation, the Textbook of Neonatal Resuscitation published by the American Academy of Pediatrics (AAP) and the American Heart Association (AHA) as the reference work for the Neonatal Resuscitation Program (NRP).3 Rather, seeks to provide an overview of neonatal resuscitation, discussing not only the current state of the scientific evidence and clinical guidelines but also the gaps in present knowledge and the developments likely to occur in the future.
DEVELOPMENT OF NEONATAL RESUSCITATION GUIDELINES
The management of neonates in the DR may have far-reaching consequences, not only on their subsequent neonatal course but also on their long-term outcome. Ideally, all of the interventions undertaken in the DR should be based on the best-available scientific evidence. However, prospective, sufficiently powered, randomized controlled trials (RCTs) of interventions undertaken during neonatal resuscitation are uncommon. Neonatal resuscitation involving more than drying, warming, stimulation, suctioning, and brief positive-pressure ventilation (PPV) is a low-frequency event; in addition, it is hard to anticipate, making RCTs with or without informed consent difficult to undertake. So, how are guidelines for neonatal resuscitation developed?
The development of neonatal resuscitation guidelines involves 2 distinct processes, each carried out on a quinquennial basis. To determine the best-available evidence on which to base recommendations for clinical care, a review of the published science is undertaken by members of the neonatal delegations to the International Liaison Committee on Resuscitation (ILCOR). ILCOR is an international body of health care professionals (HCPs) from resuscitation councils in the United States, Canada, South America, Europe, Australia, New Zealand, South Africa, and other countries and areas of the world whose members volunteer literally thousands of hours in pursuit of thorough, objective review ...