RESUSCITATION AT BIRTH

It is only in recent years that the techniques used for resuscitation at birth have come under critical review and there have been very few controlled trials to assess their efficacy. Recent studies have indica ted that the large majority of asphyxiated term babies can be resuscit ated using air rather than 100% oxygen, possibly reducing damage from oxygen free radicals during re-perfusion. Physiological studies have s hown that inflation pressures of 25-30 cmH(2)O maintained for up to 1 s, only result in approximately 40% of the mean inspiratory volume ach ieved by babies who breathed spontaneously at birth. These spontaneous inflation volumes call be matched either by maintaining the first inf lation for 3 s, or by using pressures of up to 50 cmH(2)O for 300 ms, a pattern adopted by spontaneously breathing babies. nag and mask syst ems are even less effective,, often depending on the Head paradoxical reflex to stimulate respiration rather than producing adequate tidal e xchange. Face mask T-piece devices provide more effective ventilatory exchange and are easier to use. Conclusion Although the pattern of ven tilatory support in current use often leads to successful resuscitatio n of asphyxiated babies at birth, more physiological and randomised co ntrolled studies are needed to refine techniques in order to limit bab ies' exposure to potentially damaging hypoxia to the minimum.