ILCOR advisory statement: Resuscitation of the newly born infant - An advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation

The International Liaison Committee on Resuscitation (ILCOR), with represen tation from North America, Europe, Australia, New Zealand, Africa, and Sout h America, was formed in 1992 to provide a forum for liaison between resusc itation organizations in the developed world. This consensus document on re suscitation extends previously published ILCOR advisory statements on resus citation to address the unique and changing physiology of the newly born in fant within the first few hours after birth and the techniques for providin g advanced life support. After careful review of the international resuscitation literature and afte r discussion of key and controversial issues, consensus was reached on almo st all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitati on for the newly born infant included the following principles: Personnel trained in the basic skills of resuscitation should be in attenda nce at every delivery. A minority (fewer than 10%) of newly born infants re quire active resuscitative interventions to establish a vigorous cry and re gular 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 bor n 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 jud ged 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 remain s <60 bpm despite adequate assisted ventilation for 30 seconds. Chest compr essions should be coordinated with ventilations at a ratio of 3:1 and a rat e of 120 "events" per minute to achieve approximately 90 compressions and 3 0 rescue breaths per minute. Epinephrine should be administered intravenously or intratracheally if the heart rate remains <60 bpm despite 30 seconds of effective assisted ventila tion and chest compression circulation. Common or controversial medications (epinephrine, volume expansion, naloxon e, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethi cal considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend ch anges to current guidelines regarding the use of 21% versus 100% oxygen, ne uroprotective interventions such as cerebral hypothermia, use of a laryngea l mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to impr ove the scientific justification of each component of current and future re suscitation guidelines.