Clinics in perinatology
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Clinics in perinatology · Dec 2012
ReviewOptimal timing for clamping the umbilical cord after birth.
This article provides a brief overview of pros and cons of clamping the cord too early (within seconds) after birth. It also highlights evolving data that suggest that delaying cord clamping for 30 to 60 seconds after birth is beneficial to the baby, with no measurable negative effects either the baby or the mother.
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As recently as the year 2000, 100% oxygen was recommended to begin resuscitation of depressed newborns in the delivery room. However, the most recent recommendations of the International Liaison Committee on Resuscitation counsel the prudent use of oxygen during resuscitation. In term and preterm infants, oxygen therapy should be guided by pulse oximetry that follows the interquartile range of preductal saturations of healthy term babies after vaginal birth at sea level. This article reviews the literature in this context, which supports the radical but judicious curtailment of the use of oxygen in resuscitation at birth.
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Clinics in perinatology · Dec 2012
ReviewMedications in neonatal resuscitation: epinephrine and the search for better alternative strategies.
Epinephrine remains the primary vasopressor for neonatal resuscitation complicated by asystole or prolonged bradycardia not responsive to adequate ventilation and chest compressions. Epinephrine increases coronary perfusion pressure primarily through peripheral vasoconstriction. Current guidelines recommend intravenous epinephrine administration (0.01-0.03 mg/kg). ⋯ High-dose intravenous epinephrine poses additional risks and does not result in better long-term survival. Vasopressin has been considered an alternative to epinephrine in adults, but there is insufficient evidence to recommend its use in newborn infants. Future research will focus on the best sequence for epinephrine administration and chest compressions.
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Clinics in perinatology · Dec 2012
ReviewChest compressions for bradycardia or asystole in neonates.
When effective ventilation fails to establish a heart rate of greater than 60 bpm, cardiac compressions should be initiated to improve perfusion. The 2-thumb method is the most effective and least fatiguing technique. ⋯ Oxygen (100%) is recommended during compressions and can be reduced once adequate heart rate and oxygen saturation are achieved. Limited clinical data are available to form newborn cardiac compression recommendations.
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Clinics in perinatology · Dec 2012
ReviewResuscitation of preterm infants: delivery room interventions and their effect on outcomes.
Despite advances in neonatal care, the rate of oxygen dependence at 36 weeks' postmenstrual age or bronchopulmonary dysplasia has not fallen. Neonatologists are increasingly careful to apply ventilation strategies that are gentle to the lung in the neonatal intensive care unit. ⋯ A lung-protective strategy should start immediately after birth to establish a functional residual capacity, reduce volutrauma and atelectotrauma, facilitate gas exchange, and improve oxygenation during neonatal transition. This article discusses techniques and equipment recommended by international resuscitation guidelines during breathing assistance in the delivery room.