++
The vast majority of newborn infants have a successful transition
from intrauterine to extrauterine life without need of assistance;
however, approximately 10% require some degree of resuscitative
support in the delivery room.1 The presence of
certain antepartum, intrapartum, or postpartum risk factors predicts
many but certainly not all infants who require help in the delivery
room (Table 42-1). Premature, when compared
to term infants, are at particular risk for having difficulty with
transition following birth. The most common contributing factor
for infants in need of resuscitation is asphyxia. Asphyxia is a
lack of gas exchange; it results in concomitant hypoxia and hypercapnia
and causes a mixed metabolic and respiratory acidosis. The asphyxia can
result from either failure of placental gas exchange before birth
or deficient pulmonary gas exchange once the newborn is delivered.
++++
Prompt, effective reversal of asphyxia (with a major focus on effective
ventilation) can potentially prevent and certainly minimize
multiorgan failure, death, and disability. Nearly 1 million newborns
worldwide die from birth asphyxia.1 As a result,
development of competence in effective newborn resuscitation has the
potential to make a profound global impact on the health of children.
++
Anticipation and planning for both expected and unexpected neonatal
emergencies is essential for success. If a fetus is at high risk for needing resuscitation
in the delivery room, antepartum triage to a center with expertise
in high-risk stabilization should be attempted if it is safe to do
so. Regardless, every birth should have at least 1 person immediately
available to focus solely on the newborn to assess the ...