new guidelines

[Guest galaxy_7]

the new australian neonatal resuscitation guidelines is out in the january/februrary issue of journal of paediatric and child health

New Australian Neonatal Resuscitation guidelines

Colin Morley*

Abstract: New Australian Neonatal Resuscitation Guidelines highlight the recent advances in neonatal resuscitation. Resuscitation should start with air and only use oxygen if the infant does not respond. CPAP and PEEP should be considered for premature infants with meconium stained liquor. Sucking out the mouth and nose is not necessary. Infants less than 28 weeks gestation should be placed in a polyethylene bag or wrap to keep warm. Chest compressions, when required, remain at 3:1 inflation. The endotracheal tube position must be verified with a carbon dioxide detector.

[kpsanghvi]

'Sucking out the mouth and nose is not necessary' is different from saying do not do it. From the abstract it is not clear which suction are they talking about. Is it suction on perineum after delivery of head in meconium stained liquor only or not to suction any baby and clear its airway after delivery.

As for starting resuscitation in room air is a bold step and contrary to the AAP guidelines.

[pooperscooperrn0624]

I assume NRP guidelines are the same there as here in the states, but I am not sure. I am an NRP instructor here and I think what the "not suctioning" is referring to no longer suctioning before delivering of the shoulders during meconium delivery. Also, though I think evidence has proven that PPV on room air is sufficent in most cases at delivery, the AAP isn't wanting to stick its neck out that far. As far as oxygen delivery is concerned- term infants that are cyanotic recommendations of 100% or any time PPV is given. It also states that if O2 isn't available to use PPV on room air (??what other option do we have!).

Recommendations on infants less than 32 weeks is to use a blender and pulse ox begining between 21-100% stating there is no evidence study to recommend particular staring point.

[kpsanghvi]

Hi All

If the Australians and Canadians have stuck their neck out (About starting resuscitation in Room air) why aren' t the Americans doing it.

Are there any guidelines from the European countries.

I am still not convinced about not doing oropharyngeal suctioning at the perineum based on just 1 study. If at all it saves times after the child has been delivered. Would like your comments

[Guest Salma]

Hi, can you please send the link

Regards

[JACK]

Hi, can you please send the link

Regards

http://www3.interscience.wiley.com/journal/117968651/abstract

[Francesco Cardona]

Here is the link to the European guidelines by the ERC from 2005 (the most current version)

ERC guidelines

look under 6c: Air or 100% oxygen

At present, the standard approach to resuscitation

is to use 100% oxygen. Some clinicians may

elect to start resuscitation with an oxygen concentration

less than 100%, including some who

may start with air. Evidence suggests that this

approach may be reasonable.

To admit we dont comply with the recommendation and start off with 40% oxygen - so we are somewhere in the middle..

[emanyou66]

dear sir

I noticed that use of air

doesnot improve the baby quickly so the ressusitator may use extra pressure to have rapid results eventually leading to pneumo thorax

[drqayyum1]

The main reason to start with room air is the fear of having ROP or increased incidence of BPD/CLD. Oxygen is not the only factor in causation. At the other end the prematures have already a fragile brain which can easily be damaged by improper resuscitation and proper oxygenation is an important factor for a successful resuscitation. We usually start with 100% oxygen but within minutes as the saturation improves, bay is administered blended oxygen mixed with air. We still have to report a case of ROP in our NICU where we have successfully resuscitated babies from last one decade. This seems opposite to Australian guidelines where room air is advised as a starter and gradually the oxygen percentage may be increased.

[kpsanghvi]

It is not ROP and BPD in full term infants which has led to the recent recommendations to start resuscitation in Room Air but damage to neurons caused by Free Oxygen radicals

[Ruth]

I do local neonatal resuscitation training based on the AAP and SAPA guidleines.We are recommending that babies are ventilated with room air for 30secs and then if they do not pink up or respond then to introduce oxygen. Unfortunately fewlabour wards here have blenders yet so this 100%

[emanyou66]

I not it better to use 100% o2 specially with ababy who is trying to breath with dificulty than wait and use bag and mask .also the use of high % of o2might decrease the time needed for ressuscitatoun and unnecessary bagging. lastlly i would like if any one has some guide to some precise way of o2 to the neoborne that I will be sure of the % I am giving and if Idonot have a blender can I use a venturi mask.

[drgeojose]

i totally agree to this writer about the use of 100% fio2, i believe free radical injury does occur on prolonged administration of high conc o2. but if you have caused a hypoxic injury to the brain by restricting o2 during resuscitation,that can be more detrimental to the infant.So practically even most units are not bold enough to abide by the room air guidelines at birth.I guess it would be prudent to start on 100% fio2 during resuscitation and to gradually reduce as per the requirement , thereby avoiding long standing radical injury and immediate hypoxic injury

dr george jose

SH medical centre

kottayam,kerala,india