Raktima Chakrabarti
Most infants adapt well after birth to extra-uterine life without any active resuscitation. 85% infants breathe spontaneously, a further 10% respond after drying, temperature maintenance, stimulation, and airway opening manoeuvres. Only 5 % neonates receive positive pressure ventilation. Only 0.2-4 % babies need to be intubated at the time of birth. Less than 0.3 % babies need chest compression and only 0.05% babies need adrenaline.
For a successful resuscitation a well-orchestrated team is required containing well trained nurse and neonatologist with proper preparation of equipment is required. . 1). As a guide,
• Personnel competent in new born life support should be available for every delivery.
• If intervention is required, there should be personnel available whose sole responsibility is to care for the infant.
• A process should be in place for rapidly mobilising a team with sufficient resuscitation skills for any birth specifically where risk factors are present.
There are some rent changes in the guidelines of resuscitation:
• Delayed cord clamping
• Special care for infants with meconium stained liqor, specifically who are non-vigorous
• If facemask is not useful and intubation is difficult, there is a role of laryngeal mask airway
• Gradual increase of inflation pressure has a role in initiation of respiration where airway is open.
• There is a role of air/oxygen in preterm delivery
• 100% oxygen is required with chest compression
• Intraosseus route has a role in emergency access of medicines and fluid
• Adrenaline and 10% dextrose are important medicines in the resuscitation kit
• Failure to respond despite 10-20 minutes of intensive resuscitation is associated with high risk of poor outcome.