PEDIATRICS Vol. 103 No. 4 April 1999, p. e56

ELECTRONIC ARTICLE:
An Advisory Statement From the Pediatric Working Group of the International Liaison Committee on Resuscitation

Received Jan 14, 1999; accepted Jan 14, 1999.

John Kattwinkel^*, , Susan Niermeyer^{*, §}, Vinay Nadkarni^{*, §}, James Tibballs, Barbara Phillips^¶, David Zideman^¶, Patrick Van Reempts^¶, and Martin Osmond^#

From the ^* American Academy of Pediatrics;  Neonatal Resuscitation Program; ^§ American Heart Association;  Australian Resuscitation Council; ^¶ European Resuscitation Council; and ^# Heart and Stroke Foundation of Canada.

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support.

After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly born infant included the following principles:

• Personnel trained in the basic skills of resuscitation should be in attendance at every delivery. A minority (fewer than 10%) of newly born infants require active resuscitative interventions to establish a vigorous cry and regular respirations, maintain a heart rate >100 beats per minute (bpm), and maintain good color and tone.
• When meconium is present in the amniotic fluid, it should be suctioned from the hypopharynx on delivery of the head. If the meconium-stained newly born infant has absent or depressed respirations, heart rate, or muscle tone, residual meconium should be suctioned from the trachea.
• Attention to ventilation should be of primary concern. Assisted ventilation with attention to oxygen delivery, inspiratory time, and effectiveness judged by chest rise should be provided if stimulation does not achieve prompt onset of spontaneous respirations and/or the heart rate is <100 bpm.
• Chest compressions should be provided if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. Chest compressions should be coordinated with ventilations at a ratio of 3:1 and a rate of 120 "events" per minute to achieve approximately 90 compressions and 30 rescue breaths per minute.
• Epinephrine should be administered intravenously or intratracheally if the heart rate remains <60 bpm despite 30 seconds of effective assisted ventilation and chest compression circulation.

Common or controversial medications (epinephrine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines.

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