Neonatology pp 423-438 | Cite as

Resuscitation of the Newborn

  • Ola D. SaugstadEmail author
Reference work entry


In 2015, the International Liaison Committee on Resuscitation estimated that 85% of babies born at term will initiate spontaneous respirations within 10–30 s of birth. In the USA, 5–10% of all newborn infants require basic life support in the delivery room or nursery. There are similar figures for Western Europe.

Approximately 1% of newborns require more extensive resuscitation procedures. Recent estimates indicate that worldwide 814,000 die and an equal number develops sequels after birth asphyxia. Thus, it is important to anticipate which infants are at risk, and the antepartum and intrapartum history often can be a help in predicting which infants will need resuscitation.


  1. Allwood AC, Madar RJ, Baumer JH et al (2003) Changes in resuscitation practice at birth. Arch Dis Child Fetal Neonatal Ed 88:F375–F379CrossRefGoogle Scholar
  2. Azzopardi DV, Strohm B, Edwards AD, TOBY Study Group et al (2009) Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 361:1349–1358. [Erratum in: N Engl J Med 2010;362:1056]CrossRefGoogle Scholar
  3. Barber CA, Wyckoff MH (2006) Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room. Pediatrics 118:1028–1034CrossRefGoogle Scholar
  4. Björklund LJ, Ingimarsson J, Curstedt T et al (1997) Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatr Res 42:348–355CrossRefGoogle Scholar
  5. Black RE, Cousens S, Johnson HL, Child Health Epidemiology Reference Group of WHO and UNICEF et al (2010) Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375:1969–1987CrossRefGoogle Scholar
  6. Brugada M (2008) Using intensive care technology in the delivery room: a new concept for the resuscitation of extremely preterm neonates. Pediatrics 122:1113–1116CrossRefGoogle Scholar
  7. Christman C, Hemway RJ, Wyckoff MH, Perlman JM (2011) The two-thumb is superior to the two-finger method for administering chest compressions in a manikin model of neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed 96:F99–F101CrossRefGoogle Scholar
  8. Dawson JA, Kamlin CO, Wong C et al (2010a) Changes in heart rate in the first minutes after birth. Arch Dis Child Fetal Neonatal Ed 95:F177–F181CrossRefGoogle Scholar
  9. Dawson JA, Kamlin CO, Vento M et al (2010b) Defining the reference range for oxygen saturation for infants after birth. Pediatrics 125:e1340–e1347CrossRefGoogle Scholar
  10. Emergency Cardiac Care Committee and Subcommittees of the American Heart Association (1992) Guidelines for cardiopulmonary resuscitation and emergency cardiac care, IV: pediatric basic life support. J Am Med Assoc 268:2276–2281CrossRefGoogle Scholar
  11. Escrig R, Arruza L, Izquierdo I et al (2008) Achievement of targeted saturation values in extremely low gestational age neonates resuscitated with low or high oxygen concentrations: a prospective, randomized trial. Pediatrics 121:875–881CrossRefGoogle Scholar
  12. Finer N, Leone T (2009) Oxygen saturation monitoring for the preterm infant: the evidence basis for current practice. Pediatr Res 65:375–380CrossRefGoogle Scholar
  13. Finer NN, Horbar DH, Carpenter JH, the Vermont Oxford Network (1999) Cardiopulmonary resuscitation in the very low birth weight infant: the Vermont Oxford Experience. Pediatrics 104:428–434CrossRefGoogle Scholar
  14. Finer NN, Rich W, Wang C, Leone T (2009) Airway obstruction during mask ventilation of very low birth weight infants during neonatal resuscitation. Pediatrics 123:865–869CrossRefGoogle Scholar
  15. Garey DM, Ward R, Rich W et al (2008) Tidal volume threshold for colorimetric carbon dioxide detectors available for use in neonates. Pediatrics 121:e1524–e1527CrossRefGoogle Scholar
  16. Gupta V, Bhatia BD, Mishra OP (1996) Meconium stained amniotic fluid: antenatal, intrapartum and neonatal attributes. Indian Pediatr 33:293–297PubMedGoogle Scholar
  17. International Liaison Committee on Resuscitation (2005) International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 7: neonatal resuscitation. Resuscitation 67:293–303CrossRefGoogle Scholar
  18. Jobe AH, Ikegami M (1998) Mechanisms initiating lung injury in the preterm. Early Hum Dev 53:81–94CrossRefGoogle Scholar
  19. Jobe AH, Kramer BW, Moss TJ et al (2002) Decreased indicators of lung injury with continuous positive expiratory pressure in preterm lambs. Pediatr Res 52:387–392CrossRefGoogle Scholar
  20. Kamlin CO, O’Donnell CO, Everest NJ et al (2006) Accuracy of clinical assessment of infant heart rate in the delivery room. Resuscitation 71:319–321CrossRefGoogle Scholar
  21. Kattwinkel J, Niermeyer S, Nadkarni V et al (1999) Resuscitation of the newly born infant: an advisory statement from the pediatric working Group of the International Liaison Committee on resuscitation. Resuscitation 40:71–88CrossRefGoogle Scholar
  22. Kattwinkel J, Perlman JM, Aziz K et al (2010) Part 15: neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122(18 Suppl 3):S909–S919CrossRefGoogle Scholar
  23. Lakshminrusimha S, Russell JA, Steinhorn RH et al (2006) Pulmonary arterial contractility in neonatal lambs increases with 100% oxygen resuscitation. Pediatr Res 59:137–141CrossRefGoogle Scholar
  24. Lakshminrusimha S, Russell JA, Steinhorn RH et al (2007) Pulmonary hemodynamics in neonatal lambs resuscitated with 21%, 50%, and 100% oxygen. Pediatr Res 62:313–318CrossRefGoogle Scholar
  25. Leone TA, Rich W, Finer NN (2005) Neonatal intubation: success of pediatric trainees. J Pediatr 146:638–641CrossRefGoogle Scholar
  26. Leone TA, Lange A, Rich W, Finer NN (2006a) Disposable colorimetric carbon dioxide detector use as an indicator of a patent airway during noninvasive mask ventilation. Pediatrics 118:e202–e204CrossRefGoogle Scholar
  27. Leone TA, Rich W, Finer NN (2006b) A survey of delivery room resuscitation practices in the United States. Pediatrics 117:e164–e175CrossRefGoogle Scholar
  28. Little M, Järvelin M-R, Neasham DE et al (2007) Factors associated with fall in neonatal intubation rates in the United Kingdom-prospective study. Br J Obstet Gynaecol 114:156–164CrossRefGoogle Scholar
  29. McGowan JE, Perlman JM (2006) Glucose management during and after intensive delivery room resuscitation. Clin Perinatol 33:183–196CrossRefGoogle Scholar
  30. Milner AD, Vyas H, Hopkin IE (1984) Efficacy of facemask resuscitation at birth. Br Med J (Clin Res Ed) 289:1563–1565CrossRefGoogle Scholar
  31. Morley CJ, Davis PG (2008) Advances in neonatal resuscitation: supporting transition. Arch Dis Child Fetal Neonatal Ed 93:F334–F336CrossRefGoogle Scholar
  32. O’Donnell CP, Kamlin CO, Davis PG et al (2007) Clinical assessment of infant colour at delivery. Arch Dis Child Fetal Neonatal Ed 92:F465–F467CrossRefGoogle Scholar
  33. Palme-Kilander C, Tunell R (1993) Pulmonary gas exchange during facemask ventilation immediately after birth. Arch Dis Child 68:11–16CrossRefGoogle Scholar
  34. Palme-Kilander C, Tunell R, Chiwei Y (1993) Pulmonary gas exchange immediately after birth in spontaneously breathing infants. Arch Dis Child 68:6–10CrossRefGoogle Scholar
  35. Perlman JM (2006) Hyperthermia in the delivery: potential impact on neonatal mortality and morbidity. Clin Perinatol 33:55–63CrossRefGoogle Scholar
  36. Perlman JM, Wyllie J, Kattwinkel J, Neonatal Resuscitation Chapter Collaborators et al (2010) Part 11: neonatal resuscitation: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 122(16 Suppl 2):S516–S538CrossRefGoogle Scholar
  37. Perlman JM, Wyllie J, Kattwinkel J, Wyckoff MH et al (2015) Neonatal resuscitation chapter collaborators. Part 7: neonatal resuscitation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 132(16 Suppl 1):S204–S241CrossRefGoogle Scholar
  38. Polglase GR, Hillman NH, Pillow JJ et al (2008) Positive end-expiratory pressure and tidal volume during initial ventilation of preterm lambs. Pediatr Res 64:517–522CrossRefGoogle Scholar
  39. Poulton DA, Schmölzer GM, Morley CJ, Davis PG (2011) Assessment of chest rise during mask ventilation of preterm infants in the delivery room. Resuscitation 82:175–179CrossRefGoogle Scholar
  40. Probyn ME, Hooper SB, Dargaville PA et al (2004) Positive end expiratory pressure during resuscitation of premature lambs rapidly improves blood gases without adversely affecting arterial pressure. Pediatr Res 56:198–204CrossRefGoogle Scholar
  41. Rabi Y, Rabi D, Yee W (2007) Room air resuscitation of the depressed newborn: a systematic review and meta-analysis. Resuscitation 72:353–363CrossRefGoogle Scholar
  42. Richmond S, Wyllie J (2010) European resuscitation council guidelines for resuscitation 2010 section 7. Resuscitation of babies at birth. Resuscitation 81:1389–1399CrossRefGoogle Scholar
  43. Saugstad OD (2006) Oxygen saturations immediately after birth. J Pediatr 148:569–570CrossRefGoogle Scholar
  44. Saugstad OD (2015) Delivery room management of term and preterm newly born infants. Neonatology 107(4):365–371CrossRefGoogle Scholar
  45. Saugstad OD, Soll RF (2016) Assessing heart rate at birth: auscultation is still the gold standard. Neonatology 110:238–240CrossRefGoogle Scholar
  46. Saugstad OD, Rootwelt T, Aalen O (1998) Resuscitation of asphyxiated newborn infants with room air or oxygen: an international controlled trial: the Resair 2 study. Pediatrics 102:e1CrossRefGoogle Scholar
  47. Saugstad OD, Ramji S, Rootwelt T, Vento M (2005) Response to resuscitation of the newborn: early prognostic variables. Acta Paediatr 94:890–895CrossRefGoogle Scholar
  48. Saugstad OD, Ramji S, Soll RF, Vento M (2008) Resuscitation of newborn infants with 21% or 100% oxygen: an updated systematic review and meta-analysis. Neonatology 94:176–182CrossRefGoogle Scholar
  49. Schmölzer GM, Kamlin OC, O’Donnell CP et al (2010a) Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed 95:F393–F397CrossRefGoogle Scholar
  50. Schmölzer GM, Dawson JA, Kamlin CO et al (2010b) Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed 96(4):F254–F257CrossRefGoogle Scholar
  51. Schmölzer GM, Poulton DA, Dawson JA et al (2011) Assessment of flow waves and colorimetric CO(2) detector for endotracheal tube placement during neonatal resuscitation. Resuscitation 82:307–312CrossRefGoogle Scholar
  52. Schmörzel GM, Kamlin CO, Dawson JA et al (2010) Respiratory monitoring of neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed 95:F295–F303CrossRefGoogle Scholar
  53. Serenius F, Källén K, Blennow M et al (2013) Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA 309:1810–1820CrossRefGoogle Scholar
  54. Skupski DW, Chervenak FA, McCullough LB et al (2010) Ethical dimensions of periviability. J Perinat Med 38:579–583PubMedGoogle Scholar
  55. Solevåg AL, Dannevig I, Nakstad B, Saugstad OD (2010) Resuscitation of severely asphyctic newborn pigs with cardiac arrest by using 21% or 100% oxygen. Neonatology 98:64–72CrossRefGoogle Scholar
  56. Szyld E, Aguilar A, Musante GA, Vain N, Prudent L, Fabres J, Carlo WA, Delivery Room Ventilation Devices Trial Group (2014) Comparison of devices for newborn ventilation in the delivery room. J Pediatr 165:234–239CrossRefGoogle Scholar
  57. te Pas AB, Walther FJ (2007) A randomized, controlled trial of delivery-room respiratory management in very preterm infants. Pediatrics 120:322–329CrossRefGoogle Scholar
  58. Vento M, Moro M, Escrig R et al (2009a) Preterm resuscitation with low oxygen causes less oxidative stress, inflammation, and chronic lung disease. Pediatrics 124:e439–e449CrossRefGoogle Scholar
  59. Vento M, Cheung PY, Aguar M (2009b) The first golden minutes of the extremely-low-gestational-age neonate: a gentle approach. Neonatology 95:286–298CrossRefGoogle Scholar
  60. Victorin LH, Deverajan LV, Curstedt T, Robertson B (1990) Surfactant replacement in spontaneously breathing babies with hyaline membrane disease—a pilot study. Biol Neonate 58:121–126CrossRefGoogle Scholar
  61. Wang CL, Anderson C, Leone TA et al (2008) Resuscitation of preterm neonates by using room air or 100% oxygen. Pediatrics 121:1083–1089CrossRefGoogle Scholar
  62. Wood FE, Morley CJ, Dawson JA, Davis PG (2008) A respiratory function monitor improves mask ventilation. Arch Dis Child Fetal Neonatal Ed 93:F380–F381CrossRefGoogle Scholar
  63. World Health Organization, Department of Reproductive Health and Research (1998) Basic newborn resuscitation: a practical guide. WHO, Geneva. Scholar
  64. Wu YW, Backstrand KH, Zhao S et al (2004) Declining diagnosis of birth asphyxia in California: 1991–2000. Pediatrics 114:1584–1590CrossRefGoogle Scholar
  65. Wyckoff MH, Berg RA (2008) Optimizing chest compressions during delivery-room resuscitation. Semin Fetal Neonatal Med 13:410–415CrossRefGoogle Scholar
  66. Wyckoff MH, Perlman JM (2006) Use of high-dose epinephrine and sodium bicarbonate during neonatal resuscitation: is there proven benefit? Clin Perinatol 33:141–151CrossRefGoogle Scholar
  67. Wyckoff MH, Wyllie J (2006) Endotracheal delivery of medications during neonatal resuscitation. Clin Perinatol 33:153–160CrossRefGoogle Scholar
  68. Wyckoff MH, Perlman JM, Laptook AR (2005) Use of volume expansion during delivery room resuscitation in near-term and term infants. Pediatrics 115:950–955CrossRefGoogle Scholar
  69. Wyckoff M, Garcia D, Margraf L et al (2007) Randomized trial of volume infusion during resuscitation of asphyxiated neonatal piglets. Pediatr Res 61:415–420CrossRefGoogle Scholar
  70. Yam CH, Dawson JA, Schmölzer GM et al (2011) Heart rate changes during resuscitation of newly born infants <30 weeks gestation: an observational study. Arch Dis Child Fetal Neonatal Ed 96:F102–F107CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric ResearchRikshospitalet, Oslo University Hospital, University of OsloOsloNorway

Personalised recommendations