PEDIATRICS Vol. 106 No. 3 September 2000, p. e29

ELECTRONIC ARTICLE:
International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

Susan Niermeyer, MD, Editor John Kattwinkel, MD Patrick Van Reempts, MD Vinay Nadkarni, MD Barbara Phillips, MD David Zideman, MD Denis Azzopardi, MD Robert Berg, MD David Boyle, MD Robert Boyle, MD David Burchfield, MD Waldemar Carlo, MD Leon Chameides, MD Susan Denson, MD Mary Fallat, MD Michael Gerardi, MD Alistair Gunn, MD Mary Fran Hazinski, MSN, RN William Keenan, MD Stefanie Knaebel, MD Anthony Milner, MD Jeffrey Perlman, MD Ola Didrick Saugstad, MD Charles Schleien, MD Alfonso Solimano, MD Michael Speer, MD Suzanne Toce, MD Thomas Wiswell, MD Arno Zaritsky, MD

The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC.

As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for:

 Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway.

 Preventing heat loss: Hyperthermia should be avoided.

 Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO₂ detection can be useful in the secondary confirmation of endotracheal intubation.

 Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse.

 Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available.

 Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.

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