please download new guidelines related to resuscitation of newborn from circulation journal:)

Here's the link, chapter 15 is about neonatal resuscitation:

http://circ.ahajournals.org/content/vol122/18_suppl_3/

(seems to be free full-text!)

Finally:

In term infants receiving resuscitation at birth with positive-pressure ventilation, it is best to begin with air rather than 100% oxygen. If despite effective ventilation there is no increase in heart rate or if oxygenation (guided by oximetry) remains unacceptable, use of a higher concentration of oxygen should be considered.

and the European Version is here: http://www.resuscitationjournal.com/article/S0300-9572(10)00455-7/fulltext

Edited October 25, 201015 yr by fcardona
added link

Great Links Stefan & fcardona

Here are all new guidelines including adult , pediatric and newborn resuscitation http://www.cprguidelines.eu/2010/, you can download them, order them in printed version or posters etc... ERC members have a discount

I still remember attending NRP( First Edition ) course ( A long time ago ).....and have seen it evolve over the years. The latest edition just shows the power of Evidence Based Medicine in improving ourselves. I just hope that we will apply EBM to all aspects of Neonatology....

The European (but not the US?) guidelines make recommendations regarding cord clamping in a variety of settings, however the timings are not absolute. ( up to a minute, up to 3 minutes, "patience" when it come to cord clamping are some of the sentences in the text...

(www.Resus.org.uk)

How do you think you will implement this in your setting?

Here's the link, chapter 15 is about neonatal resuscitation:

http://circ.ahajournals.org/content/vol122/18_suppl_3/

(seems to be free full-text!)

The recommendation says:

Delay in umbilical cord clamping for at least 1min is recommended for newborn infants not requiring resuscitation.

link

and further:

For an otherwise uncomplicated preterm birth, there is evidence of a benefit to delaying cord clamping for a minimum time ranging from 30s to 3min after delivery.

admittingly not very precise but not zero. In the text they also mention, the cord should not be clamped until no more pulsations are visible.

Currently we dont practise this at our hospital, but I believe we should.

many issues have been debated on NRP'S NEW VERSION

here are few comments from Dr.Ashok Deorari and Dr.Deepak Chawala (as displayed on : http://www.newbornwhocc.org/forthcomingevents/news-oct.html)

The American Heart Association (AHA) and American Academy of Pediatrics (AAP) have recently published the neonatal resuscitation guidelines 2010 , as a part of the international consensus on cardiopulmonary resuscitation and emergency cardiovascular care. These neonatal resuscitation guidelines undoubtedly incorporate complete and most recent evidence on various aspects of resuscitation. The current guidelines have proposed paradigm changes with respect to the existing practices based on AHA/AAP 2005 recommendations like - use of room air for resuscitation, monitoring of oxygenation with pulse oximetry even in term babies, underplaying the role of assessment of color, endorsing delayed cord clamping and therapeutic hypothermia etc, which are enumerated below (Table 1).

Unfortunately the AHA and APA in their quest for evidence-based medicine have partly ignored the feasibility and scalability of these guidelines in resource-limited settings, which bear the maximum burden of intrapartum related neonatal deaths. The current guidelines, in its present form are tailor-made for guiding resuscitation in tertiary care centers, with limited practical applicability in resource(financial and manpower)-crunched low- and middle-income countries, primarily due to recommending use of costly equipments like pulse oximetry, blenders for graded increase in supplemental oxygen etc, thereby making the whole process complex and less user friendly. However there are positive welcome changes like use of room air for initiation of resuscitation and less vigorous push for tracheal suctioning in non- vigorous neonates born through meconium-stained amniotic fluid.

There is an urgent need for policy makers and stakeholders in resource-limited settings to generate simpler, less technology-driven recommendations for newborn resuscitation, keeping in mind the larger interests and needs of their countries. These recommendations should provide a middle path between the current AHA/AAP resuscitation guidelines and the Helping Babies Breathe resuscitationalgorithm5 for peripheral health workers.

what are your views....?

Dr. Maulik Shah

neonatologist

Jamnagar (gujarat-india)

I agree that the old guideline cannot apply to all hospital in developing countries but the new one is extremely for developed country.I wonder that the old guideline(NRP2005) can be used in all hospital in developed countries or not.

6th Edition of NRP from AAP/AHA is coming out soon

http://neoreviews.aappublications.org/cgi/content/abstract/neoreviews;11/12/e673

It seems that they will have plenty of changes in how the NRP course is conducted....

http://www.aap.org/nrp/provider/screencast.html#start

thanks for the link jack