title: [Controversies about the resuscitation of extremely preterm infants in the delivery room].
abstract: OBJECTIVE
  To describe the main controversies about resuscitation procedures performed in extremely low birth weight infants in the delivery room.
  
  
  METHODS
  Systematic review including articles from MEDLINE, SciELO and Cochrane Library, and abstracts published in national and international proceedings, using the keywords resuscitation, asphyxia, and newborn infant.
  
  
  RESULTS
  The main controversies concern the oxygenation and ventilation of extremely low birth weight infants. The effects of oxygen concentrations between 21 and 100% need to be addressed. Appropriate inspiratory pressure, lung volume, and positive end-expiratory pressure parameters also need to be established in order to decrease barotrauma and volutrauma. The benefits of nasal continuous positive airway pressure may be determined through randomized clinical trials. On top of that, manual resuscitation devices have to be developed in order to optimize these ventilatory parameters and to reduce lung injury. So far, clinical trials on the administration of epinephrine, volume expanders, and sodium bicarbonate to extremely low birth weight infants have not been published. In addition, the main ethical dilemma concerns the decision of health professionals and parents not to initiate resuscitation procedures at very low gestational ages.
  
  
  CONCLUSIONS
  In the future, guidelines may be modified based on the results of randomized and controlled clinical trials, as well as neurodevelopmental follow-up studies, involving extremely low birth weight infants submitted to resuscitation procedures in the delivery room.
authors.affiliation: Departamento de Pediatria, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina. fernandaalmeida@uol.com.br
authors.forename: Maria Fernanda Branco
authors.initials: MF
authors.lastname: de Almeida
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
mesh_terms: D003696:Delivery Rooms; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007442:Intubation, Intratracheal; D010102:Oxygen Inhalation Therapy; D012123:Pulmonary Ventilation; D012151:Resuscitation / Q000941:ethics / Q000379:methods*