[Resuscitation of newborn infants].
Although almost 10% of all newborn infants need some form of respiratory assistance after birth, only 1% will require more advanced forms of resuscitation. Because these rare events cannot always be anticipated, pediatricians and neonatologists may not be readily available and resuscitation will have to be performed by anesthesiologists. In recent years, international guidelines for neonatal resuscitation have been revised by the International Liaison Committee on Resuscitation (ILCOR), the American Academy of Pediatrics (AAP) and the American Heart Association (AHA), as well as the European Resuscitation Council (ERC). The revised guidelines describe a simplified resuscitation algorithm which emphasizes the central role of respiratory support and an increase in heart rate is judged to be the best marker for successful ventilation. In deliveries complicated by meconium-stained amniotic fluid, intrapartum suctioning of the oropharynx is no longer recommended and endotracheal suctioning is restricted to severely depressed babies. The new guidelines mention the use of the laryngeal mask airway (LMA) and CO(2) detectors without, however, making firm recommendations. The use of 100% oxygen in neonatal resuscitation is increasingly being challenged. In the rare event of a newborn whose heart rate drops below 60 beats/min, more advanced resuscitation (chest compressions using the 2-thumb-encircling-hands technique, epinephrine 10-30 mug/kgBW i.v.) will be required. Finally, the guidelines mention the possible neuroprotective effect of therapeutic hypothermia after asphyxia, but finally only recommend that hyperthermia should be avoided.
Berger
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Neonatologische und pädiatrische Intensivpflegestation, Kinderspital Luzern, 6000 Luzern, Schweiz. thomas.berger@ksl.ch
Pilgrim
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D000222:Adaptation, Physiological / Q000502:physiology; D000465:Algorithms; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000628:therapy*; D012039:Regional Blood Flow / Q000502:physiology; D012121:Respiration, Artificial; D015656:Respiratory Mechanics; D012151:Resuscitation