Clinics in perinatology
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Clinics in perinatology · Mar 2006
ReviewInitial ventilation strategies during newborn resuscitation.
Ventilation alone is usually effective in most neonatal resuscitation episodes. A review of the evidence underpinning recommendations for methods and devices for providing initial ventilation during newborn resuscitation was conducted. ⋯ The best indication of successful ventilation is a prompt increase in heart rate. The role of positive end-expiratory pressure during resuscitation requires further research, particularly in preterm infants, in whom it may protect against lung injury.
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Clinics in perinatology · Mar 2006
ReviewTemperature control of premature infants in the delivery room.
The body temperature of preterm babies can drop precipitously after delivery, and this hypothermia is associated with an increase in mortality and morbidity. Reports of hypothermia in babies of all birth weights, on admission to neonatal units, have come from all over the world; most also report increased mortality in association with hypothermia. Recent reports that showed that hypothermia on admission to neonatal units is an independent risk factor for mortality in preterm babies have refocused attention on the need for meticulous thermal care immediately after birth and during resuscitation. Their data lend weight to the view that conventional approaches to thermal care of the very preterm and low birth weight baby are outmoded.
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Clinics in perinatology · Mar 2006
ReviewNaloxone during neonatal resuscitation: acknowledging the unknown.
There are no studies to support or to refute the current recommendations regarding naloxone concentration, routes for administration, and doses in neonatal resuscitation in the delivery room. Given the lack of supporting evidence, naloxone should not be given routinely in the delivery room to depressed neonates whether or not they are exposed to opioids before delivery because no important improvement has been documented and the drug may have potential short- and long-term harmful effects.
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Adequate circulating volume to maintain mean arterial blood pressure above a critical value is necessary to reverse bradycardia by positive-pressure ventilation during resuscitation after asphyxia. A variety of circumstances can lead to visible or occult blood loss in the perinatal period; however, distinguishing hypovolemic shock from asphyxial shock can be difficult in the delivery room. ⋯ No trials have compared crystalloid and colloid for volume expansion in the setting of immediate resuscitation after birth. Further work is needed to refine the approach to infants in whom adequate positive-pressure ventilation fails and to better discriminate between shock on the basis of hypovolemia versus decreased myocardial function.
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Clinics in perinatology · Mar 2006
ReviewUse of high-dose epinephrine and sodium bicarbonate during neonatal resuscitation: is there proven benefit?
For adults and pediatric age patients, high-dose intravenous epinephrine was recommended if standard-dose epinephrine failed to achieve return of spontaneous circulation. More recent trials suggest that high-dose epinephrine is not beneficial and may result in increased harm. There are no randomized clinical studies of high-dose versus standard-dose intravenous epinephrine in neonates. ⋯ Sodium bicarbonate infusion during neonatal cardiopulmonary resuscitation (CPR) has several known and potential side effects. The use of sodium bicarbonate infusion should be discouraged during brief CPR. Whether sodium bicarbonate is beneficial for infants who require prolonged CPR despite adequate ventilation is unknown.