Excerpt from Neonatal Resuscitation

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Neonatal resuscitation skills are essential for all health care providers who are involved in the delivery of newborns. The transition from fetus to newborn requires intervention by a skilled individual or team in approximately 10% of all deliveries. This figure is concerning because 81% of all babies in the United States are born in nonteaching nonaffiliated level I or II hospitals. In such hospitals, the volume of delivery service may not be perceived to economically justify the continuous in-hospital presence of personnel with high-risk delivery room experience as recommended by the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) in Guidelines for Perinatal Care.

Perinatal asphyxia and extreme prematurity are the 2 complications of pregnancy that most frequently require a complex resuscitation by skilled personnel. However, only 60% of asphyxiated newborns can be predicted antepartum. The remaining newborns are not identified until the time of birth. Additionally, approximately 80% of low birth weight infants require resuscitation and stabilization at delivery. Nearly one half of newborn deaths (many of which are extremely premature infants) occur during the first 24 hours following birth. A number of these early deaths also have a component of asphyxia and/or respiratory depression as an etiology. For the surviving infants, effective management of asphyxia in the first few minutes of life may influence long-term outcome.

Even though prenatal care is able to identify many potential fetal difficulties antepartum, allowing maternal transfer of care to the referral center, many women who experience preterm labor are not identified prospectively, therefore not allowing the appropriate maternal transfer to a tertiary perinatal center. Consequently, many deliveries of extremely premature infants occur in smaller hospitals. For this reason, all personnel involved in delivery room care of the newborn should be trained adequately in all aspects of neonatal resuscitation.

This chapter reviews the adaptation to extrauterine life and the steps necessary to optimally resuscitate neonates. Along with the necessary skills, the practitioner should approach any resuscitation with a good comprehension of transitional physiology and adaptation, as well as an understanding of the infant's response to resuscitation. Resuscitation involves knowing much more than an ordered list of skills and having a resuscitation team; it requires excellent assessment skills and a grounded understanding of physiology.

Please click here to view the full topic text: Neonatal Resuscitation