European Resuscitation Council Guidelines for Resuscitation 2010: Section 7. Resuscitation of babies at birth
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:
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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.
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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:
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Protect the baby from draughts.
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Keep the delivery room warm. For babies less than 28 weeks gestation the delivery room temperature should be 26 °C.8, 9
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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
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Both authors contributed equally to this manuscript and share first authorship.