Elsevier

Resuscitation

Volume 81, Issue 10, October 2010, Pages 1389-1399
Resuscitation

European Resuscitation Council Guidelines for Resuscitation 2010: Section 7. Resuscitation of babies at birth

https://doi.org/10.1016/j.resuscitation.2010.08.018Get rights and content

Introduction

The following guidelines for resuscitation at birth have been developed during the process that culminated in the 2010 International Consensus Conference on Emergency Cardiovascular Care (ECC) and Cardiopulmonary Resuscitation (CPR) Science with Treatment Recommendations.1, 2 They are an extension of the guidelines already published by the ERC3 and take into account recommendations made by other national and international organisations.

Section snippets

Summary of changes since 2005 Guidelines

The following are the main changes that have been made to the guidelines for resuscitation at birth in 2010:

  • For uncompromised babies, a delay in cord clamping of at least 1 min from the complete delivery of the infant, is now recommended. As yet there is insufficient evidence to recommend an appropriate time for clamping the cord in babies who are severely compromised at birth.

  • For term infants, air should be used for resuscitation at birth. If, despite effective ventilation, oxygenation (ideally

Preparation

Relatively few babies need any resuscitation at birth. Of those that do need help, the overwhelming majority will require only assisted lung aeration. A small minority may need a brief period of chest compressions in addition to lung aeration. Of 100,000 babies born in Sweden in 1 year, only 10 per 1000 (1%) babies of 2.5 kg or more appeared to need resuscitation at delivery.4 Of those babies receiving resuscitation, 8 per 1000 responded to mask inflation and only 2 per 1000 appeared to need

Temperature control

Naked, wet, newborn babies cannot maintain their body temperature in a room that feels comfortably warm for adults. Compromised babies are particularly vulnerable.5 Exposure of the newborn to cold stress will lower arterial oxygen tension6 and increase metabolic acidosis.7 Prevent heat loss:

  • Protect the baby from draughts.

  • Keep the delivery room warm. For babies less than 28 weeks gestation the delivery room temperature should be 26 °C.8, 9

  • Dry the term baby immediately after delivery. Cover the

Initial assessment

The Apgar score was proposed as a “simple, common, clear classification or grading of newborn infants” to be used “as a basis for discussion and comparison of the results of obstetric practices, types of maternal pain relief and the effects of resuscitation” (our emphasis).10 It was not designed to be assembled and ascribed in order to then identify babies in need of resuscitation.11 However, individual components of the score, namely respiratory rate, heart rate and tone, if assessed rapidly,

Newborn life support

Commence newborn life support if assessment shows that the baby has failed to establish adequate regular normal breathing, or has a heart rate of less than 100 min−1. Opening the airway and aerating the lungs is usually all that is necessary. Furthermore, more complex interventions will be futile unless these two first steps have been successfully completed.

Maintaining normal temperature in preterm infants

Significantly preterm babies are likely to become hypothermic despite careful application of the traditional techniques for keeping them warm (drying, wrapping and placing under radiant heat).24 Several randomised controlled trials and observational studies have shown that placing the preterm baby under radiant heat and then covering the baby with food-grade plastic wrapping without drying them, significantly improves temperature on admission to intensive care compared with traditional

First page preview

First page preview
Click to open first page preview

References (124)

  • R. Lenclen et al.

    Use of a polyethylene bag: a way to improve the thermal environment of the premature newborn at the delivery room

    Arch Pediatr

    (2002)
  • L.J. Bjorklund et al.

    Reducing heat loss at birth in very preterm infants

    J Pediatr

    (2000)
  • S. Vohra et al.

    Heat Loss Prevention (HeLP) in the delivery room: a randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants

    J Pediatr

    (2004)
  • B.S. Carson et al.

    Combined obstetric and pediatric approach to prevent meconium aspiration syndrome

    Am J Obstet Gynecol

    (1976)
  • P. Ting et al.

    Tracheal suction in meconium aspiration

    Am J Obstet Gynecol

    (1975)
  • H.S. Falciglia et al.

    Does DeLee suction at the perineum prevent meconium aspiration syndrome?

    Am J Obstet Gynecol

    (1992)
  • N.E. Vain et al.

    Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial

    Lancet

    (2004)
  • P.G. Davis et al.

    Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis

    Lancet

    (2004)
  • U. Felderhoff-Mueser et al.

    Oxygen causes cell death in the developing brain

    Neurobiol Dis

    (2004)
  • C.P. O’Donnell et al.

    Feasibility of and delay in obtaining pulse oximetry during neonatal resuscitation

    J Pediatr

    (2005)
  • G.A. Dildy et al.

    Intrapartum fetal pulse oximetry: fetal oxygen saturation trends during labor and relation to delivery outcome

    Am J Obstet Gynecol

    (1994)
  • G. Mariani et al.

    Pre-ductal and post-ductal O2 saturation in healthy term neonates after birth

    J Pediatr

    (2007)
  • Y. Rabi et al.

    Oxygen saturation trends immediately after birth

    J Pediatr

    (2006)
  • J.P. Brady et al.

    Heart rate changes in the fetus and newborn infant during labor, delivery, and the immediate neonatal period

    Am J Obstet Gynecol

    (1962)
  • H. Vyas et al.

    Physiologic responses to prolonged and slow-rise inflation in the resuscitation of the asphyxiated newborn infant

    J Pediatr

    (1981)
  • D. Hull

    Lung expansion and ventilation during resuscitation of asphyxiated newborn infants

    J Pediatr

    (1969)
  • H. Vyas et al.

    Intrathoracic pressure and volume changes during the spontaneous onset of respiration in babies born by cesarean section and by vaginal delivery

    J Pediatr

    (1981)
  • A.W. Boon et al.

    Lung expansion, tidal exchange, and formation of the functional residual capacity during resuscitation of asphyxiated neonates

    J Pediatr

    (1979)
  • M.F. Hird et al.

    Inflating pressures for effective resuscitation of preterm infants

    Early Hum Dev

    (1991)
  • P.S. Ganga-Zandzou et al.

    Is Ambu ventilation of newborn infants a simple question of finger-touch?

    Arch Pediatr

    (1996)
  • N.N. Finer et al.

    Comparison of methods of bag and mask ventilation for neonatal resuscitation

    Resuscitation

    (2001)
  • D. Trevisanuto et al.

    Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing?

    Resuscitation

    (2004)
  • S.T. Kempley et al.

    Endotracheal tube length for neonatal intubation

    Resuscitation

    (2008)
  • S.G. Crespo et al.

    Comparison of two doses of endotracheal epinephrine in a cardiac arrest model

    Ann Emerg Med

    (1991)
  • L.L. Mielke et al.

    Plasma catecholamine levels following tracheal and intravenous epinephrine administration in swine

    Resuscitation

    (1998)
  • J.R. Roberts et al.

    Blood levels following intravenous and endotracheal epinephrine administration

    JACEP

    (1979)
  • C. Vandycke et al.

    High dose versus standard dose epinephrine in cardiac arrest—a meta-analysis

    Resuscitation

    (2000)
  • A.M. Brambrink et al.

    Poor outcome after hypoxia-ischemia in newborns is associated with physiological abnormalities during early recovery. Possible relevance to secondary brain injury after head trauma in infants

    Exp Toxicol Pathol

    (1999)
  • Perlman JM, Wyllie J, Kattwinkel J, et al. 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency...
  • C. Palme-Kilander

    Methods of resuscitation in low-Apgar-score newborn infants—a national survey

    Acta Paediatr

    (1992)
  • L.S. Dahm et al.

    Newborn temperature and calculated heat loss in the delivery room

    Pediatrics

    (1972)
  • G.M. Gandy et al.

    Thermal environment and acid-base homeostasis in human infants during the first few hours of life

    J Clin Invest

    (1964)
  • A.L. Kent et al.

    Increasing ambient operating theatre temperature and wrapping in polyethylene improves admission temperature in premature infants

    J Paediatr Child Health

    (2008)
  • R.B. Knobel et al.

    Heat loss prevention for preterm infants in the delivery room

    J Perinatol

    (2005)
  • V. Apgar

    A proposal for a new method of evaluation of the newborn infant

    Curr Res Anesth Analg

    (1953)
  • C.P. O’Donnell et al.

    Clinical assessment of infant colour at delivery

    Arch Dis Child Fetal Neonatal Ed

    (2007)
  • P.K. Houri et al.

    A randomized, controlled trial of two-thumb vs two-finger chest compression in a swine infant model of cardiac arrest [see comment]

    Prehosp Emerg Care

    (1997)
  • R. David

    Closed chest cardiac massage in the newborn infant

    Pediatrics

    (1988)
  • M.M. Thaler et al.

    An improved technique of external caridac compression in infants and young children

    N Engl J Med

    (1963)
  • J.M. Dean et al.

    Improved blood flow during prolonged cardiopulmonary resuscitation with 30% duty cycle in infant pigs

    Circulation

    (1991)
  • Cited by (189)

    View all citing articles on Scopus
    1

    Both authors contributed equally to this manuscript and share first authorship.

    View full text