0942 Guidelines for neonatal resuscitation

A recent Dutch consensus document in the European Journal of Pediatrics provides an update on neonatal resuscitation as recommended for that country. Several of the points raised are worth noting. Temperature control is addressed and the authors make the point that preterm infants should not be dried, should be placed under a radiant warmer, and covered to the neck in a transparent, heat-resistant plastic wrapping. The head is dried and covered with a cap. Several randomized controlled trials have shown that body temperature is maintained using this approach. In cases of meconium–staining of the amniotic fluid, the authors cite literature showing that there is no benefit to intrapartum oro-nasopharyngeal suctioning in terms of the development of meconium aspiration syndrome, the need for mechanical ventilation, or mortality. The authors also come out quite strongly in favour of starting resuscitation with room air and responding with higher concentrations of oxygen only according to need. In this regard they cite a meta-analysis of 10 studies which included 6 randomised controlled trials which showed that air resuscitation actually lowered mortality (from 3.9% to 1.1%, with a number needed to harm of 36). All healthcare providers involved in neonatal resuscitation should probably take note of the evidence from several countries (Europe, USA, Australia, New Zealand) that points towards a more-conservative approach to oxygen administration in newborn resuscitation. Certainly hypoxia must be treated, but in those cases in which resuscitation is necessary but gas exchange is normal, one must recognise the potential for oxygen to be toxic.

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Eur J Pediatr DOI 10.1007/s00431-009-1091-0
Neonatol 2008; 94: 176-82
J Perinatol 2009; 29: 548-52
J Paediatr Child Health 2009; 45: 31-5