The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Neonatal Resuscitation

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Abstract
Approximately 10% of newborns require some assistance to begin breathing at birth, and about 1% require extensive resuscitation. Although the vast majority of newborn infants do not require intervention to make the transition from intrauterine to extrauterine life, the large number of births worldwide means that many infants require some resuscitation. Newborn infants who are born at term, had clear amniotic fluid, and are breathing or crying and have good tone must be dried and kept warm but do not require resuscitation. All others need to be assessed for the need to receive 1 or more of the following actions in sequence: * Initial steps in stabilization (clearing the airway, positioning, stimulating) * Ventilation * Chest compressions * Medications or volume expansion Progression to the next step is based on simultaneous assessment of 3 vital signs: respirations, heart rate, and color. Progression occurs only after successful completion of the preceding step. Approximately 30 seconds is allotted to complete 1 step successfully, reevaluate, and decide whether to progress to the next (Fig 1). FIGURE 1 ILCOR neonatal flow algorithm. a Tracheal intubation may be considered at several steps. HR indicates heart rate. Since publication of the last International Liaison Committee on Resuscitation (ILCOR) document,1 several controversial neonatal resuscitation issues have been identified. The literature was researched and a consensus was reached on the role of supplementary oxygen, peripartum management of meconium, ventilation strategies, devices to confirm placement of an advanced airway (eg, tracheal tube or laryngeal mask airway [LMA]), medications, maintenance of body temperature, postresuscitation management, and considerations for withholding and discontinuing resuscitation. ### Supplementary OxygenW202A,W202B There is growing evidence from both animal and human studies that air is as effective as 100% oxygen for the resuscitation of most infants at birth. There are concerns about potential adverse effects of 100% oxygen on breathing physiology, cerebral circulation, and …