neonatal resuscitation algorithm 2020 pdf

Ventilation should be optimized before starting chest compressions, with endotracheal intubation if possible. It is estimated that approximately 10% of newly born infants need help to begin breathing at birth,1–3 and approximately 1% need intensive resuscitative measures to restore cardiorespiratory function.4,5 The neonatal mortality rate in the United States and Canada has fallen from almost 20 per 1000 live births6,7 in the 1960s to the current rate of approximately 4 per 1000 live births. The decision to continue or discontinue resuscitative efforts should be individualized and should be considered at about 20 minutes after birth. World Restart A Heart 2019 . The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual publications from the International Liaison Committee on Resuscitation (ILCOR) for neonatal life support (NLS). The primary goal of neonatal care at birth is to facilitate transition. 2020 American Heart Association Chains of Survival for IHCA and OHCA. The 2020 guidelines are organized into “knowledge chunks, ” grouped into discrete modules of information on specific topics or management issues.22 Each modular knowledge chunk includes a table of recommendations using standard AHA nomenclature of COR and LOE. PPV may be initiated with air (21% oxygen) in term and late preterm babies, and up to 30% oxygen in preterm babies. If the heart rate remains less than 60/min despite these interventions, chest compressions can supply oxygenated blood to the brain until the heart rate rises. Disclosure information for peer reviewers is listed in Appendix 2. Umbilical venous catheterization has been the accepted standard route in the delivery room for decades.2 There are no human neonatal studies to support one route over others.1, There are 6 case reports indicating local complications of intraosseous needle placement.3–8. Article Type: Supplement Article . View the 2020 AHA Guidelines for CPR and ECC in the AHA's flagship journal, Circulation. The “newly born” period extends from birth to the end of resuscitation and stabilization in the delivery area. Team training remains an important aspect of neonatal resuscitation, including anticipation, preparation, briefing, and debriefing. Thank you for your interest in spreading the word on American Academy of Pediatrics. Free Resources for Neonatal Resuscitation Exam Preparation . Positive-pressure ventilation (PPV) remains the main intervention in neonatal resuscitation. 1. In circumstances of altered or impaired transition, effective neonatal resuscitation reduces the risk of mortality and morbidity. Supplemental oxygen should be used judiciously, guided by pulse oximetry. Commenting is now closed. World Restart A Heart 2018. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual publications from the International Liaison Committee on Resuscitation (ILCOR) for neonatal life support (NLS). In the delivery room setting, the primary method of vascular access is umbilical venous catheterization. In addition, some conditions are so severe that the burdens of the illness and treatment greatly outweigh the likelihood of survival or a healthy outcome. Other important goals include establishment and maintenance of cardiovascular and temperature stability as well as the promotion of mother-infant bonding and breast feeding, recognizing that healthy babies transition naturally. See Summary of Japanese Neonatal Cardiopulmonary Resuscitation Guidelines 2015 by Hosono et al. These courses satisfy Instructors’ required, official 2020 AHA Guidelines Instructor Update. Most newborns who are apneic or have ineffective breathing at birth will respond to initial steps of newborn resuscitation (positioning to open the airway, clearing secretions, drying, and tactile stimulation) or to effective PPV with a rise in heart rate and improved breathing. A newly born infant in shock from blood loss may respond poorly to the initial resuscitative efforts of ventilation, chest compressions, and/or epinephrine. Identification of risk factors for resuscitation may indicate the need for additional personnel and equipment. The following sections are worth special attention. All guidelines were reviewed and approved for publication by the AHA Science Advisory and Coordinating Committee and AHA Executive Committee. Infants 36 weeks’ or greater estimated gestational age who receive advanced resuscitation should be ex-amined for evidence of HIE to determine if they meet criteria for therapeutic hypothermia. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual publications from the International Liaison Committee on Resuscitation (ILCOR) for neonatal life support (NLS). The American Heart Association is a qualified 501(c)(3) tax-exempt organization. Clinical assessment of heart rate by auscultation or palpation may be unreliable and inaccurate.1–4 Compared to ECG, pulse oximetry is both slower in detecting the heart rate and tends to be inaccurate during the first few minutes after birth.5,6,10–12 Underestimation of heart rate can lead to potentially unnecessary interventions. We do not capture any email address. These 2020 AHA neonatal resuscitation guidelines are based on the extensive evidence evaluation performed in conjunction with the ILCOR and affiliated ILCOR member councils. CPAP indicates continuous positive airway pressure; ECG, electrocardiographic; ETT, endotracheal tube; HR, heart rate; IV, intravenous; O2, oxygen; Spo2, oxygen saturation; and UVC, umbilical venous catheter. Author: American Heart Association Subject: Please contact the American Heart Association at ECCEditorial@heart.org or 1-214-706-1886 to request a long description of this image. Part 5: neonatal resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. COVID-19 Guidance . Consequently, all newly born babies should be attended to by at least 1 person skilled and equipped to provide PPV. Peak inflation pressures of up to 30 cm H2O in term newborns and 20 to 25 cm H2O in preterm newborns are usually sufficient to inflate the lungs.5–7,9,11–14 In some cases, however, higher inflation pressures are required.5,7–10 Peak inflation pressures or tidal volumes greater than what is required to increase heart rate and achieve chest expansion should be avoided.24,26–28, The lungs of sick or preterm infants tend to collapse because of immaturity and surfactant deficiency.15 PEEP provides low-pressure inflation of the lungs during expiration. Because evidence and guidance are evolving with the COVID-19 situation, this interim guidance is maintained separately from the ECC guidelines. doi: 10.1161/ CIR.0000000000000902 October 20, 2020 S545. A randomised comparison of resuscitation with an anaesthetic rebreathing circuit or an infant ventilator in very preterm infants, From liquid to air: breathing after birth, Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth, Positive end expiratory pressure during resuscitation of premature lambs rapidly improves blood gases without adversely affecting arterial pressure, T-piece versus self-inflating bag ventilation in preterm neonates at birth, Oxygenation with T-piece versus self-inflating bag for ventilation of extremely preterm infants at birth: a randomized controlled trial, Delivery Room Ventilation Devices Trial Group. Neonatal life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, Recent Innovations, Modifications, and Evolution of ACC/AHA Clinical Practice Guidelines: An Update for Our Constituencies: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines, Early initiation of basic resuscitation interventions including face mask ventilation may reduce birth asphyxia related mortality in low-income countries: a prospective descriptive observational study, Standardised formal resuscitation training programmes for reducing mortality and morbidity in newborn infants, Impact of neonatal resuscitation trainings on neonatal and perinatal mortality: a systematic review and meta-analysis, A prospective clinical audit of neonatal resuscitation practices in Canada, Risk factors 1. for advanced resuscitation in term and near-term infants: a case-control study, Implementing Delivery Room Checklists and Communication Standards in a Multi-Neonatal ICU Quality Improvement Collaborative, Promoting teamwork may improve infant care processes during delivery room management: Florida perinatal quality collaborative’s approach, Tennessee Initiative for Perinatal Quality Care Golden Hour Project Team. Comparison of devices for newborn ventilation in the delivery room, T-piece or self inflating bag for positive pressure ventilation during delivery room resuscitation: an RCT, National Institute of Child Health and Human Development Neonatal Research Network, Delivery room continuous positive airway pressure/ positive end-expiratory pressure in extremely low birth weight infants: a feasibility trial, Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep, Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room, Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs, Lung recruitment at birth does not improve lung function in immature lambs receiving surfactant, Tidal volume effects on surfactant treatment responses with the initiation of ventilation in preterm lambs, Sustained inflation vs standard resuscitation for preterm infants: a systematic review and meta-analysis, on behalf of the SAIL Site Investigators. There is an emphasis on skills development and practice to improve PPV. Three different types of evidence reviews (systematic reviews, scoping reviews, and evidence updates) were used in the 2020 … Adult Cardiac Arrest Algorithm. ECG provides the most rapid and accurate measurement of the newborn’s heart rate at birth and during resuscitation. Epidemiology — Scope Download. ... Neonatal resuscitation Download. Stimulation may be provided to facilitate respiratory effort. Although current guidelines recommend using 100% oxygen while providing chest compressions, no studies have confirmed a benefit of using 100% oxygen compared to any other oxygen concentration, including air (21%). The 2015 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) recommended against routine endotracheal suctioning for both vigorous and nonvigorous infants born with meconium-stained amniotic fluid (MSAF). In addition, accurate, fast, and continuous heart rate assessment is necessary for newborns in whom chest compressions are initiated. Very low-quality evidence from 8 nonrandomized studies2,5,6,10,12–15 enrolling 615 newborns and 2 small RCTs7,16 suggests that at birth, ECG is faster and more accurate for newborn heart assessment compared with pulse oximetry. However, it may be reasonable to increase inspired oxygen to 100% if there was no response to PPV with lower concentrations. Gaps in this domain, whether perceived or real, should be addressed at every stage in our research, educational, and clinical activities. There is an emphasis on skills development and practice to improve PPV. When the need for resuscitation is not anticipated, delays in assisting a newborn who is not breathing may increase the risk of death.1,5,13 Therefore, every birth should be attended by at least 1 person whose primary responsibility is the newborn and who is trained to begin PPV without delay.2–4, A risk assessment tool that evaluates risk factors present during pregnancy and labor can identify new-borns likely to require advanced resuscitation; in these cases, a team with more advanced skills should be mobilized and present at delivery.5,7 In the absence of risk stratification, up to half of babies requiring PPV may not be identified before delivery.6,13, A standardized equipment checklist is a comprehensive list of critical supplies and equipment needed in a given clinical setting. It is the expert opinion of national medical societies that conditions exist for which it is reasonable to not initiate resuscitation or to discontinue resuscitation once these conditions are identified.1,2,4,5, 2. National guidelines recommend individualization of parent-informed decisions based on social, maternal, and fetal/neonatal factors.1,2,4 A systematic review showed that international guidelines variably described periviability between 22 and 24 weeks’ gestational age.7.

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