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Neonatal resuscitation

Key sources
The following summarized guidelines for the evaluation and management of neonatal resuscitation are prepared by our editorial team based on guidelines from the American Heart Association (AHA/AAP 2023), the International Liaison Committee on Resuscitation (ILCOR 2022), the American Heart Association (AHA 2020), and the American College of Obstetricians and Gynecologists (ACOG 2017).
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Guidelines

1.Diagnostic investigations

Heart rate assessment: as per ILCOR 2022 guidelines, consider obtaining an ECG, when resources permit, for HR assessment in infants requiring resuscitation in the delivery room.
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2.Respiratory support

Airway clearing
As per ILCOR 2022 guidelines:
Avoid performing suctioning of clear amniotic fluid from the nose and mouth at birth as a routine step.
D
Consider performing airway positioning and suctioning if airway obstruction is suspected.
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  • Noninvasive positive pressure ventilation

  • Supplemental oxygen

3.Medical management

Vascular access
Prefer the umbilical vein in infants requiring vascular access at the time of delivery.
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Consider using the intraosseous route if intravenous access is not feasible.
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  • Volume resuscitation

  • Epinephrine

4.Nonpharmacologic interventions

Temperature management: as per ILCOR 2022 guidelines, consider maintaining the room temperature of 23 °C at birth in order to maintain a normal temperature in late preterm and term infants (≥ 34 weeks gestation).
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  • Tactile stimulation

5.Therapeutic procedures

Cardiopulmonary resuscitation: consider initiating chest compressions if the HR after birth remains at < 60/minute despite adequate ventilation for at least 30 seconds.
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  • Umbilical cord clamping

  • Umbilical cord milking

6.Specific circumstances

Patients with meconium aspiration syndrome: do not perform intrapartum suctioning in infants with meconium-stained amniotic fluid, regardless of whether they are vigorous or not.
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7.Follow-up and surveillance

Discontinuation of resuscitation: view non-initiation of resuscitation and discontinuation of life-sustaining treatment during or after resuscitation as ethically equivalent.
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  • Post-resuscitation care

8.Quality improvement

Pre-resuscitation preparation: ensure that every birth is attended by at least 1 specialist able to perform the initial steps of neonatal resuscitation and initiate positive pressure ventilation, and whose only responsibility is the care of the newborn.
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  • Health professional training