Neonatal Resuscitation Guidilenes 2015 update

Even if neonatal cardiac arrest is not a common clinical scenario, it is a big concern for all the professionals involved in emergency medicine practice.

While on adult and pediatric cardiac arrest updated guidelines much (despite few key changes) was said or written, on neonatal part of the updated guidelines there is not much to read or to hear.

I think this particular aspect of cardipulmonary resuscitation worths a specific focus (see references for full free text of the guidelines).

So here is a brief summary of the key recommendations:

• Usual care (remaining with the mother) is applicable to all term infants who are breathing or crying and have good tone.
• Infants not meeting those criteria should be warmed (36.5^o–37.5^oC), dried, and stimulated. Suctioning should only be performed if is present airway obstruction is present or suspected .
• Pressure ventilation by self-inflating bag, flow-inflating bag, or other ventilatory device, initially by room air, shoul be performed on labored or ineffective respirations or heart rate <100/min. after 60 seconds . Supplemental oxygen has to be started and targeted to preductal pulse oximetry norms.
• Intubation is indicated only after ineffective or prolonged bag-mask ventilation, chest compressions, or congenital diaphragmatic hernia.
• Laryngeal masks are an alternative to intubation for newborns at ≥34 weeks of gestation.
• If despite effective positive pressure ventilation heart rates remains <60/min. chest compressions using the 2-thumb-encircling-hands technique has to be started at a 3:1 compressions/ventilation ratio.
• Consider induced therapeutic hypothermia for infants born at >36 weeks of gestation with moderate-to-severe hypoxic-ischemic encephalopathy.
• Termination of resuscitative efforts has to be considered if the 10-minute Apgar score is 0 associated with undetectable heart rate.

By Mario Rugna

References:

1. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care- Free full text

2. Updated International Guidelines for Neonatal Resuscitation, Katherine Bakes, MD reviewing Wyckoff MH et al. Circulation 2015 Nov 3.