Clinics in perinatology
-
Clinics in perinatology · Sep 1999
Historical ArticleHistory of neonatal resuscitation. Tales of heroism and desperation.
Although the history of neonatal resuscitation is as old as medicine itself, today's standards of practice evolved over the past 40 years. Most ancient physicians and midwives did know that stimulation and expansion of lungs was needed to revive the "apparently dead" newborn, but the means of providing these 'therapies' varied from brutal shaking, hitting, swinging, electrocuting, hanging upside-down to applying gentle pressures or squeezing of the chest. ⋯ Even after great advances in medical science in the 19th century, cardiopulmonary resuscitation techniques remained primitive until the mid-1950s. In this article the author has traced some elements of cardiopulmonary resuscitation techniques and developed an outline of the history of neonatal resuscitation.
-
Expertise in neonatal resuscitation is essential for all hospital personnel involved in the care of newborn infants. The guidelines to resuscitation reviewed here have been established by the American Academy of Pediatrics and the American Heart Association and have resulted in significantly improved training and expertise of delivery room personnel. Although widely accepted, many of these guidelines are only now being rigorously studied in controlled trials. This lack of rigorous testing has raised some questions regarding routine resuscitative practices and indicates that present-day standard therapies must always be under constant review.
-
The American Heart Association has published guidelines for medication use in neonatal resuscitation. These recommendations should not, however, be regarded as standards or as the final word on resuscitation in neonates. Little work has been performed to justify these recommendations directly; therefore, it was necessary to make recommendations by extrapolating from studies not specifically designed to answer questions concerning the neonate. ⋯ The American Heart Association guidelines were made with reasoning based on the information available, even though the information is tangential. Similarly, since no data exist to document the benefit of NaHCO3 and some data would suggest harmful effects, its routine use is discouraged. Fertile areas for research exist to define better the optimum doses of epinephrine required in newborn resuscitation and to further delineate the importance and safety of rapid reversal of acidosis in newborn resuscitation.