Clinics in perinatology
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Clinics in perinatology · Mar 2006
ReviewIntraosseous access for administration of medications in neonates.
Intraosseous administration of resuscitation medications and fluids in preterm and term neonates is an alternative when intravascular access is not possible with intravenous catheters or needles. Intraosseous access is rarely needed in neonates because of the availability of clinicians with expert technical skills for placement of intravenous catheters in neonatal ICUs, the presence of the umbilical vein during the first days after birth when most resuscitations occur, and the predominance of resuscitations being responsive to positive-pressure ventilation alone. Intraosseous access is most likely to be needed in out-of-hospital settings and in hospitalized infants without intravenous access who have vascular collapse secondary to shock or when clinicians responsible for vascular access during resuscitations are more skilled in intraosseous access than intravenous access.
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Clinics in perinatology · Mar 2006
ReviewModest hypothermia as a neuroprotective strategy in high-risk term infants.
This article briefly reviews the pathogenesis of hypoxic-ischemic cerebral injury, the experimental data, and clinical studies that have evaluated the potential therapeutic benefit of modest selective or whole body hypothermia in reducing the subsequent development of irreversible brain injury without untoward side effects. Data are insufficient to recommend routine use of either modest selective or whole body hypothermia after resuscitation of infants with suspected asphyxia. Further clinical trials are needed to determine which infants would benefit most and which method of cooling would be most effective.
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The appropriate role for laryngeal masks during delivery room resuscitation has not been established. The authors systematically reviewed the literature to answer three clinical questions: (1) In newborns requiring positive-pressure ventilation for resuscitation, would a laryngeal mask achieve safe and effective ventilation faster than facemask ventilation? (2) In newborns unable to be ventilated effectively with a facemask during resuscitation, would a laryngeal mask achieve effective ventilation faster than endotracheal intubation? (3) In newborns requiring resuscitation, would a laryngeal mask achieve effective ventilation when facemask ventilation and endotracheal intubation have been unsuccessful?
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Clinics in perinatology · Mar 2006
ReviewThe role of carbon dioxide detectors for confirmation of endotracheal tube position.
There is evidence that practitioners who are responsible for airway management at newborn resuscitations may place an endotracheal tube incorrectly with confidence. Moving on to the further stages of resuscitation, without managing the airway adequately, and commencing ventilation has the potential for significant harm to the baby. ⋯ Symmetric chest movement, auscultation, exhaled carbon dioxide (CO(2)), and an increase in heart rate have been suggested as providing secondary confirmation. Measurement of exhaled CO(2) is accepted widely as a standard of care in adult and pediatric intensive care and in anaesthetized patients.
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Clinics in perinatology · Mar 2006
ReviewEndotracheal delivery of medications during neonatal resuscitation.
If the endotracheal route is to be used for administration of epinephrine, the limited available evidence suggests that the currently recommended dose of 0.01 mg/kg is likely to be too low to be effective. Given the paucity of high-quality clinical data regarding endotracheal epinephrine, the intravenous route should be used as soon as venous access is established. Given the complete lack of clinical data in newborns, endotracheal administration of naloxone is not recommended.