Seminars in neonatology : SN
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The possibility that temperature may affect the outcome of resuscitation from severe perinatal asphyxia has been a long-standing focus of research. Experimentally it is now well established that even small changes in temperature during severe hypoxia-ischemia critically modulate outcome. Clinical and experimental studies have now shown that hypoxic-ischemic injury continues to evolve after resuscitation. ⋯ Indeed there are data indicating that moderate post-ischemic hyperthermia can be deleterious as late as 24 h after reperfusion. Hypothermia has significant potential adverse effects, and at present its clinical use is restricted to large randomized controlled trials. The present paper reviews evidence suggesting that both primary prevention of maternal pyrexia during labour, and secondary prevention of hyperthermia after neonatal resuscitation, have the potential to significantly reduce the consequences of perinatal hypoxia-ischemia.
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Medication use during neonatal resuscitation is uncommon. The infrequent use of resuscitation medications has impeded rigorous investigations to determine the most effective agents and/or dosing regimens. The medications most commonly used during delivery room resuscitation include epinephrine, sodium bicarbonate, naloxone hydrochloride and volume expanders. The available evidence for each of these medications is reviewed in this article.
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Oxygen is a toxic agent and a critical approach regarding its use during resuscitation at birth is developing. Animal data indicate that room air is efficient for newborn resuscitation. ⋯ There are limited data regarding the use of room air during complicated resuscitations, i.e. in meconium aspiration, the severely asphyxiated infant and in the preterm infant. Thus, it is necessary to continue ongoing rigorous examination of the long-accepted practice of oxygen administration during neonatal resuscitation.