- 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