Neonatal resuscitation: evolving strategies

摘要: Birth asphyxia accounts for about 23% of the approximately 4 million neonatal deaths each year worldwide (Black et al, Lancet, 2010, 375(9730):1969-87). The majority newborn infants require little assistance to undergo physiologic transition at birth and adapt extrauterine life. Approximately 10% some establish regular respirations birth. Less than 1% need extensive resuscitative measures such as chest compressions 0.06% epinephrine (Wyllie Resuscitation, 81 Suppl 1:e260-e287). Transition is mediated by significant changes in circulatory respiratory physiology. Ongoing research field resuscitation has expanded our understanding physiology enabling implementation improved recommendations guidelines on how best approach newborns intervention Many these are extrapolated from animal models clinical trials adults. There many outstanding controversial issues that be addressed. This article provides a comprehensive critical literature review most relevant current pertaining evolving new strategies resuscitation. key elements successful include ventilation lungs while minimizing injury, judicious use oxygen improve pulmonary blood flow, support with compressions, vasopressors volume would hasten return spontaneous circulation. Several exciting avenues delayed cord clamping, sustained inflation breaths, alternate vasopressor agents briefly discussed. Finally, efforts developing countries through education basic steps likely decrease mortality.