Neonatal resuscitation

Neonatal resuscitation also known as newborn resuscitation is an emergency procedure focused on supporting the approximately 10%[1] of newborn children who do not readily begin breathing, putting them at risk of irreversible organ injury and death. Through positive airway pressure, and in severe cases chest compressions, medical personnel can often stimulate neonates to begin breathing on their own, with attendant normalization of heart rate. [2]

About a quarter of all neonatal deaths globally are caused by birth asphyxia.[3] This dangerous condition of oxygen deprivation may begin before birth, for example if the umbilical cord, which supplies oxygen throughout fetal development, is compressed during delivery. Depending on how quickly and successfully the infant is resuscitated, hypoxic damage can occur to most of the infant's organs (heart, lungs, liver, gut, kidneys), although brain injury known as neonatal hypoxic-ischemic encephalopathy is of most concern.

The International Liaison Committee on Resuscitation (ILCOR) has published Consensus on science and treatment recommendations for neonatal resuscitation in 2000, 2005 and 2010. Traditionally, newborn children have been resuscitated using mechanical ventilation with 100% oxygen, but there has since the 1980s increasingly been debated whether newborn infants with asphyxia should be resuscitated with 100% oxygen or normal air, and notably Ola Didrik Saugstad has been a major advocate of using normal air.[4][5] It has been demonstrated that high concentrations of oxygen lead to generation of oxygen free radicals, which have a role in reperfusion injury after asphyxia.[6] Clinical trial evidence suggests that resuscitation using air probably reduces the risk of death[7] and the 2010 ILCOR guidelines recommend the use of normal air rather than 100% oxygen.[8]

For preterm infants, there may be little or no difference in risk of death or neurodevelopment disability when higher concentrations of oxygen are used compared to lower concentrations but the evidence from clinical trials is still relatively uncertain.[9]