Neonatal resuscitation:  foetal physiology and pathophysiological aspects.
Although approximately 10% of all newborn infants receive some form of assistance after birth, only 1% of neonates require more advanced measures of life support. Because such situations cannot always be anticipated, paediatricians and neonatologists are frequently unavailable and resuscitation is delegated to the anaesthesiologist. The International Liaison Committee on Resuscitation, the European Resuscitation Council and the American Heart Association have recently updated the guidelines on neonatal resuscitation. The revised guidelines propose a simplified resuscitation algorithm that highlights the central role of respiratory support and promotes an increasing heart rate as the best indicator for effective ventilation. The most striking change in the new guidelines is the recommendation to start resuscitation in term infants with room air rather than 100% oxygen. Continuous pulse oximetry is recommended to monitor both heart rate and an appropriate increase in preductal oxygen saturation. Supplemental oxygen should only be used if, despite effective ventilation, the heart rate does not increase above 100  beats  min(-1), or if oxygenation as indicated by pulse oximetry, remains unacceptably low. This review will focus on foetal physiology and pathophysiological aspects of neonatal adaptation and, thus, attempt to provide a solid basis for understanding the new resuscitation guidelines.
Neonatal and Paediatric Intensive Care Unit, Children's Hospital of Lucerne, Lucerne, Switzerland. thomas.berger@luks.ch
Thomas M
TM
Berger
D000222:Adaptation, Physiological; D000465:Algorithms; D000776:Anesthesiology / Q000379:methods* / Q000592:standards; D016887:Cardiopulmonary Resuscitation / Q000592:standards; D005333:Fetus / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000592:standards; D010092:Oximetry; D010102:Oxygen Inhalation Therapy; D017410:Practice Guidelines as Topic; D015656:Respiratory Mechanics; D016896:Treatment Outcome