AHA 2015 Update for CPR and ECC: Neonatal Resuscitation

  • Order of 3 assessment questions has changed to
    – Term ?
    – Tone ?
    – Crying and moving ?
  • Delayed cord clamping after 30 seconds is suggested for both term and preterm infants NOT requiring resuscitation. There is insufficient evidence to recommend this in neonates needing resus
    – Previous 2010: delayed cord clamping AFTER 1 minute is recommended.
    – Delayed cord clamping is associated with higher BP, less IVH, less NEC; only downside is jaundice which can be treated with phototherapy
  • Infants with meconium stained amniotic fluid:
    – Resuscitation in radiant warmer
    – PPV is done if no breathing or HR < 100
    – Routine intubation is NOT recommended.
  • Avoid hypothermia, especially in preterm infants. Hyperthermia should be avoided.
    – Use radiant warmer, plastic wrap, thermal mattress etc to prevent hypothermia in infants
  • Low oxygen (21% = atmospheric concentration) for preterm infants initially and titrated to achieve a preductal O2 saturation approximating the healthy term infants.
    – DO NOT start with high oxygen (65% and higher). A meta analysis showed no benefit in high oxygen over low oxygen concentration.
  • TTM recommendation stays the same: for infants > 36 weeks with moderate-severe HIE
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