chunk_id stringlengths 16 16 | text stringlengths 29 2.42k |
|---|---|
a0f808153e0469cd | #### Sodium bicarbonate
- May be considered in a prolonged unresponsive resuscitation with adequate ventilation to reverse intracardiac acidosis.
- Intravenous or intraosseous:
- 1–2 mmol kg sodium bicarbonate (2–4 mL kg of 4.2% solution) by slow intravenous injection. |
ca2b5305894cfa91 | #### Intramuscular
An initial 200 microgram dose may help in the few infants who, despite resuscitation, remain apnoeic with good cardiac output when the mother is known to have received opiods in labour. Effects may be transient so continued monitoring of respiration is important. |
6e65826f6be52b19 | #### In the absence of an adequate response
Consider other factors which may be impacting on the response to resuscitation and which require addressing such as the presence of pneumothorax, hypovolaemia, congenital abnormalities, equipment failure etc. |
ccce4dfb301ff380 | #### Post-resuscitation care
Infants who have required resuscitation may later deteriorate. Once adequate ventilation and circulation are established, the infant should be cared for in, or transferred to, an environment in which close monitoring and anticipatory care can be provided. |
65fec56a9531fd6d | #### Glucose
- Monitor glucose levels carefully after resuscitation.
- Have protocols/guidance on the management of unstable glucose levels.
- · Avoid hyper- and hypoglycaemia.
- Avoid large swings in glucose concentration.
- Consider the use of a glucose infusion to avoid hypoglycaemia. |
acead87cd3854bed | ## Thermal care
- Aim to keep the temperature between 36.5 °C and 37.5 °C.
- Rewarm if the temperature falls below this level and there are no indications to consider therapeutic hypothermia (see below). |
c94e57ac95c212d7 | #### Therapeutic hypothermia
- Once resuscitated, consider inducing hypothermia to 33–34 °C in situations where there is clinical and/or biochemical evidence of significant risk of moderate or severe HIE (hypoxic-ischaemic encephalopathy).
- Ensure the evidence to justify treatment is clearly documented; include cord ... |
ee434fb50c97e7ea | #### Prognosis (documentation).
Ensure clinical records allow accurate retrospective time-based evaluation of the clinical state of the infant at birth, any interventions and the response during the resuscitation to facilitate any review and the subsequent application of any prognostic tool. |
6cffc9073c620f2c | #### Where intervention is anticipated
- Whenever possible, the decision to attempt resuscitation of an extremely preterm or clinically complex infant should be taken in close consultation with the parents and senior paediatric, midwifery and obstetric staff.
- Discuss the options including the potential need and magn... |
b22f05fcf07d5eb0 | #### For every birth
- Where intervention is required it is reasonable for mothers/fathers/ partners to be present during the resuscitation where circumstances, facilities and parental inclination allow.
- The views of both the team leading the resuscitation and the parents must be taken into account in decisions on p... |
bdee9c30d935b97d | #### Withholding and discontinuing resuscitation
- Any recommendations must be interpreted in the light of current national/regional outcomes.
- When discontinuing, withdrawing or withholding resuscitation, care should be focused on the comfort and dignity of the infant and family.
- Such decisions should ideally invo... |
bf49c3cd3640f47f | #### Discontinuing resuscitation
- National committees may provide locally appropriate recommendations for stopping resuscitation.
- When the heart rate has been undetectable for longer than 10 min after delivery review clinical factors (for example gestation of the infant, or presence/absence of dysmorphic features),... |
d7165f9b34fbe161 | #### Withholding resuscitation
- Decisions about withholding life-sustaining treatment should usually be made only after discussion with parents in the light of regional or national evidence on outcome if resuscitation and active (survival focused) treatment is attempted.
- In situations where there is extremely high ... |
90edcacf9b42ece1 | #### Transition
Survival at birth involves major physiological changes during transition from fetal to newborn life. First, lung liquid-clearance and aeration need to occur after which pulmonary gas exchange can be established.6 This critical event initiates a sequence of inter-dependent cardiopulmonary adaptations wh... |
1e4b086ae29b928e | #### Risk factors
Severalmaternal andfetal pre- and intrapartumfactors increasethe risk for compromised birth or transition and the need for resuscitation. In a recent ILCOR evidence update most recent studies confirm previously identified risk factors for needing assistance after birth.1,17 There is no universally ap... |
1190214357a72e36 | ## Staff attending delivery
It is not always possible to predict the need for stabilisation or resuscitation before an infant is born. Interventions may not be necessary but those in attendance at a delivery need to be able to undertake initial resuscitation steps effectively. It is essential that teams can respond ra... |
4799ca3dd9b9c6d3 | ## Equipment and environment
The detailed specification of the equipment required to support stabilisation and resuscitation of the newborn may vary and those using the equipment need to be aware of any limitations. Suggestions have been made on standardising an optimal layout of a resuscitation area,33 but no publish... |
f27d9624eba6f43d | #### Planned home deliveries
A systematic review of 8 studies involving 14 637 low risk planned home deliveries compared to 30 177 low risk planned hospital births concluded that the risks of neonatal morbidity and mortality were similar.35 Those attending deliveries at home need to recognise that despite risk stratif... |
1b93c3550db78c75 | #### Thermal control
Exposed, wet, newborn infants cannot maintain their body temperature in a room that feels comfortably warm for adults. The mechanisms and effects of cold stress and how to avoid these have been reviewed.72,73 Heat loss can occur though convection, conduction, radiation and evaporation meaning unpr... |
4cd0c5f988379232 | #### Thermal control
ses the risk of metabolic acidosis. Compromised infants are particularly vulnerable to cold stress. The admission temperature of newborn non-asphyxiated infants is a strong predictor of mortality and morbidity at all gestations and in all settings.74,75 ILCOR recommendations are that it should be ... |
5b6cfe3bc6e7292e | #### Thermal control
Preterm infants are especially vulnerable and hypothermia is also associated with serious morbidities such as intraventricular haemorrhage, need for respiratory support, hypoglycaemia, and in some studies late onset sepsis.49 In a European cohort study of 5697 infants <32 weeks gestation admitted ... |
abed4da68032ba70 | #### Thermal control
A Cochrane review involving 46 trials and 3850 dyads of infants >32 weeks gestation where resuscitation was not required concluded that skin-to-skin care may be effective in maintaining thermal stability (low quality evidence) and also improves maternal bonding and breast feeding rates (low to mod... |
9c9d13497bdeb91e | #### Thermal control
mature infants however caution is required in the more preterm or growth restricted infant in order to avoid hypothermia. In one single centre observational study of 55 infants between $28^{+0}$ and $32^{+6}$ weeks gestation randomised to either skin-to-skin or conventional thermal care the mean b... |
3ad796f6bfbf6b20 | #### Thermal control
Following a recent ILCOR evidence update including a Cochrane systematic review of 25 studies including 2433 preterm and low birth weight infants, treatment recommendations are unchanged from 2015. It is recommended that newborn temperatures be kept between 36.5 °C and 37.5 °C in order to reduce t... |
b8fee2843d7846bf | #### Thermal control
to reduce the metabolic stress on the infant (strong recommendation, very low quality of evidence). 1,49 For newborn preterm infants of ≤32 weeks gestation under radiant warmers in the hospital delivery room, a combination of interventions is suggested which may include raising the environmental t... |
bc569167e0a134fa | #### Thermal control
It is suggested that hyperthermia (greater than $38.0\,^{\circ}\text{C}$ ) should be avoided because it introduces potential associated risks (weak recommendation, very-low quality of evidence). In Infants born to febrile mothers have a higher incidence of perinatal respiratory compromise, neonata... |
7286f65b3ccb95d2 | #### Thermal control
Temperature monitoring is key to avoiding cold stress. However, there is very little evidence to guide the optimal placement of temperature monitoring probes on the infant in the delivery room. In an observational study of 122 preterm infants between 28 and 36 weeks gestation randomised to differe... |
7b5b26f1577ab3b8 | ### Clamping the umbilical cord
There is no universally accepted definition of 'delayed' or 'deferred' cord clamping' (DCC), only that it does not occur immediately after the infant is born. In recent systematic reviews and meta-analyses early or immediate cord clamping (ICC) has been defined as application of the cla... |
14cf7d15f5ad7baa | #### Physiology of cord clamping
Observational data, physiological studies, animal models and some clinical studies suggest that ICC, currently widely practiced and introduced primarily to prevent maternal postpartum haemorrhage, is not as innocuous as was once thought. 92,93 ICC significantly reduces ventricular prel... |
e7eaff14f12d6009 | #### **Differences with gestation**
In term infants, DCC results in the transfer of approximately 30 mL kg $^{-1}$ of blood from the placenta. $^{98}$ This improves iron status and haematological indices over the next 3–6 months in all infants and reduces need for transfusion in preterm infants. $^{99,100}$ Concerns a... |
ef92abaa1fdb2661 | #### **Differences with gestation**
In an ILCOR meta-analysis of 23 studies of 3514 eligible infants comparing ICC versus a delay of at least 30 s in preterm infants <34 weeks gestation the conclusion was that compared to ICC DCC may marginally improve survival (RR 1.02, 95% CI 0.993-1.04) (certainty of evidence moder... |
8a4cc9e418390d6c | #### **Differences with gestation**
70, 95% Cl 1.88-3.52). Infants required fewer blood transfusions (MD -0.63, 95% CI -1.08 to -0.17). No effects were seen on any of the complications of prematurity such as severe IVH, NEC or chronic lung disease, nor was there any obvious adverse impact on other neonatal or maternal... |
4d03219d59f35b7f | #### **Differences with gestation**
D 1.11 g dL $^{-1}$ 95% CI 0.40–1.82, 3 trials, 695 infants) but no impact on longer term anaemia. This updated review does not suggest clear differences in receipt of phototherapy (RR 1.28, 95% CI 0.90–1.82) (all findings low or very low certainty evidence). The analysis did not pr... |
bd68d622a34161f6 | #### **Differences with gestation**
recommend 'physiological' cord clamping (i.e. after the onset of respirations),104 although this may confer benefit.105 Physiological studies suggest that the hypoxic and bradycardic response observed after immediate clamping is not seen when clamping occurs after the first breaths.... |
d1e467fbfa0a2856 | #### **Differences with gestation**
The question of resuscitating infants with the intact cord warrants further study; in most studies of delayed cord clamping infants who required resuscitation at birth were excluded, as resuscitation could only be undertaken away from the mother. Equipment now exists that allows mot... |
e5a64ba13bc7128b | ## Initial assessment
The Apgar score was not designed to identify infants in need of resuscitation.113 However, individual components of the score, namely respiratory rate, heart rate (HR) and tone, if assessed rapidly, may help identify infants likely to need resuscitation. |
84cc5f09614113d6 | ## Tactile stimulation
Methods of tactile stimulation vary widely but the optimal method remains unknown.114,115 In preterm infants, tactile stimulation is often omitted,115 but in a single centre RCT of repetitive stimulation against standard stimulation only if deemed necessary in 51 infants between 28 and 32 weeks ... |
a9cce3ed5cd8622c | #### Tone and colour
Healthy infants are cyanosed at birth but start to become pink within approximately 30 s of the onset of effective breathing.121 Peripheral cyanosis is common and does not, by itself, indicate hypoxia. Persistent pallor despite ventilation may indicate significant acidosis, or, more rarely, hypovo... |
9f2ec5957bc6731d | #### Breathing
Not crying may be due to apnoea but can also function as a marker of inadequate breathing needing support. In an observational study of 19 977 infants just after birth in a rural hospital setting 11% were not crying, around half of whom were assessed as apnoeic. About 10% of those assessed as breathing ... |
110fd5126564df1a | #### **Airway**
With flexion and extension, the airway can become occluded. The evidence on the mechanisms of airway occlusion in the newborn is limited. A retrospective analysis of images of the airway of 53 sedated infants between 0 and 4 months undergoing cranial MRI indicates how, in extension, obstruction might o... |
8fce0a8240fb363a | #### Jaw lift
There are no studies of jaw thrust/lift in the newborn. Studies in children demonstrate that anterior displacement of the mandible enlarges the pharyngeal space through lifting the epiglottis away from the posterior pharyngeal wall, reversing the narrowing of the laryngeal
inlet. Two-person manual venti... |
bf6d9c52bf692d6c | #### Oropharyngeal/nasopharyngeal airway
Although the oropharyngeal airway (OPA) has been shown to be effective in children, $^{149}$ there is no published evidence demonstrating effectiveness in helping maintain the patency of the airway at birth. In a randomised study of 137 preterm infants where gas flow through a ... |
c7c604a673909e8a | #### **Airway obstruction**
The cause of airway obstruction is usually unknown. It may be due to inappropriate positioning of the head, laryngeal adduction, or pushing a facemask onto the mouth and nose too hard, especially in preterm infants at birth. In an animal model of premature birth Crawshaw used phase contrast... |
ab01283e60297178 | ## Oropharyngeal and nasopharyngeal suction
Oropharyngeal and nasopharyngeal suction has in newborn infants not been shown to improve respiratory function and may delay other necessary manoeuvres and the onset of spontaneous breathing, Consequences may include irritation to mucous membranes, laryngospasm, apnoea, vaga... |
d5ee6ff1483437f8 | ## Oropharyngeal and nasopharyngeal suction
m, apnoea, vagal bradycardia, hypoxaemia, desaturation and impaired cerebral blood flow regulation. 155–159 A recent ILCOR scoping review of 10 studies (8 RCTs,1 observational study and 1 case study) into the suctioning of clear fluid involving >1500 mainly term/near-term in... |
579894cbfb307058 | ## Oropharyngeal and nasopharyngeal suction
There have been few studies investigating the effectiveness of suction devices for clearing the newborn airway. An in vitro study using simulated meconium demonstrated the superiority of the Yankauer sucker in clearing particulate matter when compared to large bore (12 –14F)... |
ead936c1960c1932 | ## Oropharyngeal and nasopharyngeal suction
single-handed use and effectiveness at lower vacuum pressures which may be less likely to damage mucosa. A meconium aspirator, attached to a tracheal tube functions in a similar manner and can be used to remove tenacious material from the trachea. These devices should be con... |
3ef5ae56dd1f3ce6 | ## Meconium
Lightly meconium-stained liquor is common and does not, in general, give rise to much difficulty with transition. The less common finding of very thick meconium-stained liquor is an indicator of perinatal distress and should alert to the potential need for resuscitation. |
280fb0df066c8d77 | ## Meconium
There is no evidence to support intrapartum suctioning nor routine intubation and suctioning of vigorous infants born through meconiumstained liquor.162,163 Retrospective registry based studies do not demonstrate an increase in morbidity following a reduction in delivery room intubation for meconium.164,16... |
82f7c8f728905738 | ## Meconium
cluding a further RCT with 132 infants derived similar conclusions.166 A post policy change impact analysis of the resuscitation of 1138 non-vigorous neonates born through meconium-stained amniotic fluid, found reduced NICU admissions and no increase in the incidence of Meconium Aspiration Syndrome (MAS) w... |
653047c2ae7379ed | ## Meconium
Routine suctioning of non-vigorous infants may result in delays in initiating ventilation although some newborn infants may still require laryngoscopy with or without tracheal intubation in order to clear a blocked airway or for subsequent ventilation. Therefore, in apnoeic or ineffectively breathing infan... |
9bc9d1d2e16abf92 | ## Meconium
In infants with respiratory compromise due to meconium aspiration, the routine administration of surfactant or bronchial lavage with either saline or surfactant is not recommended.170,171 |
3a265a5e02052bd9 | #### Initial inflations and assisted ventilation
After initial assessment at birth, if breathing efforts are absent or inadequate, lung aeration is the priority and must not be delayed. An observational study in low resource settings suggested those resuscitating took around 80 55 s to commence ventilation with a 16% ... |
0a6417f74432af4e | ## Inflation pressure and duration
In newborn infants, spontaneous breathing or assisted initial inflations create the functional residual capacity (FRC).9,173 When assisting ventilation, the optimum inflation pressure, inflation time and flow required to establish an effective FRC are subject to technical and biologi... |
f5074de305bbfa19 | ## Inflation pressure and duration
longer duration although there is a lack of evidence demonstrating advantage or disadvantage over other recommended approaches. Once an airway is established, five initial breaths with inflation pressures maintained for up to 23 s are suggested and may help lung expansion.49,173
The... |
937bcc1adbf90d1b | ## Inflation pressure and duration
res of 30 cm H2O are usually sufficient to inflate the liquid filled lungs of apnoeic term infants. This value was originally derived from historical studies of limited numbers of infants.173,176,177A more recent prospective study of 1237 term and near-term infants resuscitated in a ... |
7c9975512a127bec | ## Inflation pressure and duration
ly.175,179 Therefore, it is suggested that a starting pressure of 25 cm H2O would be reasonable. Acknowledging that smaller airways have greater resistance than larger airways, some preterm infants may need higher pressures than 25 cm H2O for lung inflation. |
6545808e469539ef | ## Inflation pressure and duration
The time to initiation of spontaneous breathing is reported to be inversely correlated with the peak inflation pressure and the inflation time.174 If the infant has any respiratory effort, ventilation is most effective when inflation coincides with the inspiratory efforts.181 However... |
6fa9db15fa85ab71 | ## Inflation pressure and duration
A recent observational study in preterm infants under 32 weeks suggested that the application of a mask to support breathing might induce apnoea in spontaneously breathing infants.184 However, the significance of this effect on outcome is currently unclear.185 |
d1eefa5365ed5f2c | ## Ventilation
There is limited evidence on the optimal rate of ventilation for newborn resuscitation. In an observational study of 434 mask ventilated late preterm and term infants, ventilation at a rate of about 30 min achieved adequate tidal volumes without hypocarbia and the frequency of 30 min with VTE of 1014 mL... |
64d9a9183c960b90 | ## Ventilation
The delivered tidal volume required to form the FRC may exceed that of the exhaled TV: Foglia et al. describe this as being over 12 mL kg for a term infant.183 Exhaled tidal volumes increase during the first positive pressure ventilations as aeration takes place, compliance increases and the FRC is esta... |
409e018b6b5204b7 | ## Ventilation
There are no published studies clearly determining the optimal inflation time when providing positive pressure ventilation. Longer inspiratory times may permit lower pressures.183 Observational studies on spontaneously breathing newborn infants suggest that once lung inflation has been achieved they bre... |
5cd1e722e0f512e0 | #### Assessment
The primary response to adequate initial lung inflation is a prompt improvement in heart rate.126,127 Most newborn infants needing respiratory support will respond with a rapid increase in heart rate within 30 s of lung inflation.188 Chest wall movement usually indicates aeration/inflation. This may no... |
fcd4de1c3a08c749 | #### Assessment
Failure of the heart rate to respond is most likely secondary to inadequate airway control or inadequate ventilation. Mask position or seal may be suboptimal.182,190,191 Head/Airway position may be in need of adjustment.146 Inflation pressures may need to be higher to achieve adequate inflation/tidal v... |
5df944d55b14c7f0 | #### Assessment
Using a two-person approach to mask ventilation reduces mask leak in term and preterm infants and is superior to the single handed approach.191,193 Published evidence on the incidence of physical matter as a cause of obstruction is lacking but it is recognised that meconium or other matter (e.g. blood,... |
73435373f01e1e86 | ## Sustained inflations (SI) > 5 s
italisation (moderate quality evidencelimitations in study design). There was no benefit for SI vs. intermittent ventilation for the secondary outcomes of intubation, need for respiratory support or BPD (moderate quality evidence).197 |
965ab97b2fc448f1 | ## Sustained inflations (SI) > 5 s
A large multicentre RCT which was not included in this analysis investigating effects of SI vs. IPPV among extremely preterm infants (2326 weeks gestational age) concluded that a ventilation strategy involving 2 SIs of 15 s did not reduce the risk of BPD or death at 36 weeks postmens... |
2eaa974b98e71c1a | ## Sustained inflations (SI) > 5 s
A recent ILCOR systematic review identified 10 eligible RCTs including those above with 1509 newborn infants.1 For the primary outcome of death before discharge no significant benefit or harm was noted from the use of SI >1 s (actually >5 s) compared to PPV with inflations of 1 s (lo... |
fe12115cfb76bae8 | ## Sustained inflations (SI) > 5 s
ng on the secondary critical outcomes of longterm neurodevelopmental outcome or death at follow up. Subgroup analysis of different lengths of SI (615 s 9 RCTs 1300 infants, >15 s 2 RCTs 222 infants) and of different inspiratory pressures (>20 mmHg 6 RCTs 803 infants, 20 mmHg 699 infa... |
08267be31c512307 | ## Sustained inflations (SI) > 5 s
Further sub-analyses excluding studies with a high risk of bias (9 RCTs 1390 infants RR 1.24 95%CI 0.921.68), studies with only a single breath (9 RCTs 1402 infants RR 1.17 95%CI 0.881.55) and those with sustained inflation with mask only (9 RCTs 1441 infants (RR 1.06 95%CI 0.611.39)... |
6b4105e7b493a205 | ## Sustained inflations (SI) > 5 s
ILCOR treatment recommendations suggest that the routine use of initial SI 5 s cannot be recommended for preterm newborn infants who receive positive pressure ventilation prompted by bradycardia or ineffective respirations at birth (weak recommendation, low-certainty evidence) but th... |
f7903d200c76fb47 | ## Sustained inflations (SI) > 5 s
There are no randomised trials comparing the use of initial breaths of 1 s with breaths of 23 s. A recent RCT in 60 preterm infants <34 weeks gestation of 23 s inflation breaths vs. a single 15 SI demonstrated no difference in minute volume or end tidal CO2. 199 Infants receiving the... |
6a48d986393f1bb6 | ## PEEP
Animal studies have shown that immature lungs are easily damaged by large tidal volume inflations immediately after birth200,201 and suggest that maintaining a PEEP immediately after birth may help reduce lung damage202,203 although one study suggests no benefit.204 PEEP applied immediately after birth improve... |
c32cb9aef56887aa | ## PEEP
PEEP is more reliably be delivered by pressure limiting devices which use continuous gas flow, like TPR devices. A recent review of the evidence undertaken by ILCOR identified two randomized trials and one quasi-randomized trial (very low quality evidence) comparing ventilation with TPR vs. SIB and reported si... |
d9e48504ce46d494 | ## PEEP
All term and preterm infants who remain apnoeic despite adequate initial steps must receive positive pressure ventilation. ILCOR treatment recommendations are unchanged from 2015, suggesting PEEP should be used for the initial ventilation for premature newborn infants during delivery room resuscitation (weak r... |
81efb7dc077f4ff2 | #### **CPAP**
A Cochrane systematic review of CPAP applied within the first 15 min of life in preterm infants <32 weeks identified 7 RCTs involving 3123 infants and concluded that CPAP reduced the need for additional breathing assistance but with insufficient evidence to evaluate prophylactic CPAP compared to oxygen t... |
1d855d16d7bc10aa | #### **CPAP**
ed initially rather than intubation and IPPV (weak recommendation, moderate certainly of evidence). 1,49,144 There are few data to guide the appropriate use of CPAP in term infants at birth. 213,214 Caution is prompted by retrospective cohort studies which suggest that delivery-room CPAP may be associate... |
ab221140f29aa5ad | #### Assisted ventilation devices
Effective ventilation in the newborn can be achieved with a flow-inflating bag (FIB), a self-inflating bag (SIB) or with a pressure limited TPR. 207,208,218–220 An attribute of a TPR device is its ability to deliver a consistent measure of PEEP or CPAP when compared to standard SIB's ... |
c954125f7185d743 | #### Assisted ventilation devices
Whilst the TPR appears to confer benefit it cannot be used in all circumstances. Unlike the TPR, the self-inflating bag can be used in the absence of a positive pressure gas supply. However, the blow-off valves of SIB are flow-dependent and pressures generated may exceed the value spe... |
4730485695cc8b75 | #### Assisted ventilation devices
be more reliably provided by the TPR. Limitations of the TPR device were identified. Resuscitation is a dynamic process where the resuscitator needs to adapt to the response or non-response of the newborn. TPR users were not as good at detecting changes in compliance as users of the S... |
484c708e8232a509 | #### Assisted ventilation devices
changes to TPR gas flow rate had significant effects on PIP, PEEP -235 and mask leak. 232 The TPR can require more training to set up properly but once in use provided more consistent ventilation than the SIB even with inexperienced operators.The SIB cannot deliver CPAP and may not be... |
147396cf3c1e6138 | #### Assisted ventilation devices
The ILCOR task force concluded that whilst the direction of evidence is shifting towards support for the use of TPR devices, until a further systematic review is conducted recommendations would remain unchanged. The 2015 consensus on science stated that the use of the TPR showed margi... |
e07e0644c92a526e | #### Facemask versus nasal prong
A problem when using a facemask for newborn ventilation is a potentially large and variable leak and loss of inflating gas volume arising from suboptimal selection of mask size and poor technique. In manikin studies using a T-piece and different masks, 50 volunteer operators had variab... |
e03be43590ca118b | #### Laryngeal mask
The laryngeal mask (LM) may be used in ventilation of the newborn, particularly if facemask ventilation or tracheal intubation is unsuccessful or not feasible.49 A recent systematic review of seven trials (794 infants) showed that the laryngeal mask was more effective than bag-mask in terms of shor... |
aba0cc1eaf7319ea | #### Tracheal tube placement
The use and timing of tracheal intubation will depend on the skill and experience of the available resuscitators. Formulae may be unreliable in determining tracheal tube lengths.250,251 Appropriate tube lengths for oral intubation derived from observational data based on gestation are show... |
c740243ca8d3af39 | #### Tracheal tube placement
The diameter of the narrowest part of the airway and varies with gestational age and size of the infant whereas the external diameter of the tube (of the same internal diameter) may vary depending on manufacturer.255 A range of differing sized tubes should be available to permit placement ... |
2108ef9a4ab8bb6c | #### Tracheal tube placement
Tracheal tube placement should be confirmed by exhaled CO2 detection (see below), the length inserted assessed visually during intubation and the tip position confirmed clinically and ideally radiographically. Markings on the tips of tracheal tubes to aid tube placement distal to the vocal... |
acf617ef9b51dd72 | #### Tracheal tube placement
urers.257 Within institutions users will likely gain familiarity with specific types. Tube position may alter during the securing process.252 A systematic review of published literature on methods of confirming correct tube placement concluded that objective assessments of tube position we... |
74c0011e813904c4 | ## End tidal CO2 and respiratory function monitoring
Detection of exhaled CO2 in addition to clinical assessment is recommended to confirm correct placement of a tracheal tube in neonates with spontaneous circulation.49 Even in VLBW infants,259,260 detecting evidence of exhaled CO2 confirms tracheal intubation in neon... |
6dbe4ac16c161c90 | ## End tidal CO2 and respiratory function monitoring
ne.260,261 However, studies have excluded infants in need of extensive resuscitation. Failure to detect exhaled CO2 strongly suggests tube misplacement, most likely oesophageal intubation or tube dislodgement.259,261 False negative end tidal carbon dioxide (ETCO2) r... |
a227e1c585d4124f | ## End tidal CO2 and respiratory function monitoring
tracheal obstruction may prevent detection of exhaled CO2 despite correct tracheal tube placement. There is a lack of evidence in the neonate as to the effect of drugs on exhaled CO2 monitoring, however studies in adults suggest drugs such as adrenaline and bicarbon... |
6540f4417286d475 | ## End tidal CO2 and respiratory function monitoring
Respiratory flow/volume monitoring268 and end tidal CO2 269,270 may be used in non-intubated patients. The effectiveness of quantitative capnography in confirming mask ventilation has been demonstrated but may not provide reliable ETCO2 values.270 The use of exhaled... |
b192dc658bf9a2c3 | #### Video-laryngoscopy
A systematic review of studies of video-laryngoscopy in newborn infants concluded by suggesting that video-laryngoscopy increases the success of intubation in the first attempt but does not decrease the time to intubation or the number of attempts for intubation (moderate to very low-certainty ... |
06dfa74b564d6ce2 | ## Term infants and late preterm infants 35 weeks
A recent ILCOR CoSTR suggests that for term and late preterm newborns (35 weeks gestation) receiving respiratory support at birth, support should start with 21% oxygen (weak recommendation, low certainty evidence).1 It recommends against starting with 100% inspired oxy... |
e9b40d910e186a4a | #### Preterm infants <35 weeks
In an ILCOR systematic review and meta-analysis of 10 RCTs and 4 cohort studies including 5697 infants comparing initial low with high inspired oxygen for preterm infants <35 weeks gestation who received respiratory support at birth, there were no statistically significant benefits or ha... |
ce9134078e6b3c91 | #### Preterm infants <35 weeks
low certainty evidence). The range selected reflects the low oxygen range used in clinical trials. Oxygen concentration should be titrated using pulse oximetry (weak recommendation, low certainty evidence).1 |
006012b79207aabf | #### Preterm infants <35 weeks
In contrast to term infants, in preterm infants the use of supplemental oxygen to reach adequate oxygenation increases breathing efforts. In an animal experimental study278 and one RCT in 52 preterm infants <30 weeks gestation,279 initiating stabilisation with higher oxygen concentration... |
06232c94025a6ffe | #### Preterm infants 32 weeks gestation.280 |
fed5977b92029f88 | #### Target oxygen saturation
The target range recommended for both term and preterm infants are similar and based upon time based values for preductal saturations in normal term infants in air.281 Consensus recommendations suggest aiming for values approximating to the interquartile range,282 or using the 25th centil... |
b5af8b75a99ed572 | #### Target oxygen saturation
A systematic review of 8 RCTs with 768 preterm infants <32 weeks involving low (30%) vs higher (60%) initial oxygen concentrations, concluded that failure to reach a minimum SpO2 of 80% at 5 min was associated with a two-fold risk of death (OR 4.57, 95% CI 1.6213.98, p < 0.05), and had an... |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.