The role of resuscitation drugs and placental transfusion in the delivery room management of newborn infants.
Medications are used rarely in newborn resuscitations and are probably justifiable in less than 0.1% of births. Doses used are mainly extrapolated from animal and adult data. Despite this, the drugs used, their order and route of administration have all been sources of controversy for many years. There have been polarised views, often focusing upon adrenaline and sodium bicarbonate and more recently new drugs such as vasopressin have been suggested, once again extrapolating from adult experience. This article examines the sparse data behind the use of any medication at birth and the poor outcome data available. The appropriate decline in the indiscriminate use of volume expansion is considered and balanced by the increasing evidence in favour of delayed clamping of the umbilical cord. Focusing on the basic steps of resuscitation, improving the quality of their application and avoiding relative hypovolaemia, must improve the quality of outcome data. The place of medications in newborn resuscitation should be regarded as experimental and still requires evidence to justify their use especially in premature babies.
The James Cook University Hospital, Middlesbrough, UK. jonathan.wyllie@stees.nhs.uk
Jonathan
J
Wyllie
Susan
S
Niermeyer
D001238:Asphyxia Neonatorum / Q000628:therapy*; D001803:Blood Transfusion; D001810:Blood Volume; D001993:Bronchodilator Agents / Q000627:therapeutic use; D000075202:Contraindications; D003696:Delivery Rooms; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D010920:Placenta / Q000098:blood supply*; D011247:Pregnancy; D012151:Resuscitation / Q000379:methods*; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D013549:Sweetening Agents / Q000627:therapeutic use; D014662:Vasoconstrictor Agents; D014667:Vasopressins
D001993:Bronchodilator Agents; D013549:Sweetening Agents; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D017693:Sodium Bicarbonate; D005947:Glucose; D004837:Epinephrine