International Guidelines for Neonatal Resuscitation

An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines.

S. Niermeyer, J. Kattwinkel, P. Van Reempts, V. Nadkarni, B. Phillips, D. Zideman, D. Azzopardi, R. Berg, David Boyle, R. Boyle, D. Burchfield, W. Carlo, L. Chameides, S. Denson, M. Fallat, M. Gerardi, A. Gunn, M. F. Hazinski, W. Keenan, S. Knaebel & 9 others A. Milner, J. Perlman, O. D. Saugstad, C. Schleien, A. Solimano, M. Speer, S. Toce, T. Wiswell, A. Zaritsky

Research output: Contribution to journalArticle

286 Citations (Scopus)

Abstract

The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: * Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. * Preventing heat loss: Hyperthermia should be avoided. * Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO(2) detection can be useful in the secondary confirmation of endotracheal intubation. * Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse. * Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available. * Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.

Original languageEnglish
JournalPediatrics
Volume106
Issue number3
StatePublished - Sep 2000
Externally publishedYes

Fingerprint

Cardiopulmonary Resuscitation
Emergency Medical Services
Resuscitation
Ventilation
Thorax
Guidelines
Meconium
Heart Rate
Delivery Rooms
Oxygen
Isotonic Solutions
Umbilicus
Laryngeal Masks
Muscle Hypotonia
Intratracheal Intubation
Positive-Pressure Respiration
Thumb
Amniotic Fluid
Carbon Monoxide
Respiratory Rate

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

International Guidelines for Neonatal Resuscitation : An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines. / Niermeyer, S.; Kattwinkel, J.; Van Reempts, P.; Nadkarni, V.; Phillips, B.; Zideman, D.; Azzopardi, D.; Berg, R.; Boyle, David; Boyle, R.; Burchfield, D.; Carlo, W.; Chameides, L.; Denson, S.; Fallat, M.; Gerardi, M.; Gunn, A.; Hazinski, M. F.; Keenan, W.; Knaebel, S.; Milner, A.; Perlman, J.; Saugstad, O. D.; Schleien, C.; Solimano, A.; Speer, M.; Toce, S.; Wiswell, T.; Zaritsky, A.

In: Pediatrics, Vol. 106, No. 3, 09.2000.

Research output: Contribution to journalArticle

Niermeyer, S, Kattwinkel, J, Van Reempts, P, Nadkarni, V, Phillips, B, Zideman, D, Azzopardi, D, Berg, R, Boyle, D, Boyle, R, Burchfield, D, Carlo, W, Chameides, L, Denson, S, Fallat, M, Gerardi, M, Gunn, A, Hazinski, MF, Keenan, W, Knaebel, S, Milner, A, Perlman, J, Saugstad, OD, Schleien, C, Solimano, A, Speer, M, Toce, S, Wiswell, T & Zaritsky, A 2000, 'International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines.', Pediatrics, vol. 106, no. 3.
Niermeyer, S. ; Kattwinkel, J. ; Van Reempts, P. ; Nadkarni, V. ; Phillips, B. ; Zideman, D. ; Azzopardi, D. ; Berg, R. ; Boyle, David ; Boyle, R. ; Burchfield, D. ; Carlo, W. ; Chameides, L. ; Denson, S. ; Fallat, M. ; Gerardi, M. ; Gunn, A. ; Hazinski, M. F. ; Keenan, W. ; Knaebel, S. ; Milner, A. ; Perlman, J. ; Saugstad, O. D. ; Schleien, C. ; Solimano, A. ; Speer, M. ; Toce, S. ; Wiswell, T. ; Zaritsky, A. / International Guidelines for Neonatal Resuscitation : An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines. In: Pediatrics. 2000 ; Vol. 106, No. 3.
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abstract = "The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: * Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. * Preventing heat loss: Hyperthermia should be avoided. * Oxygenation and ventilation: 100{\%} oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO(2) detection can be useful in the secondary confirmation of endotracheal intubation. * Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse. * Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available. * Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.",
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T2 - An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines.

AU - Niermeyer, S.

AU - Kattwinkel, J.

AU - Van Reempts, P.

AU - Nadkarni, V.

AU - Phillips, B.

AU - Zideman, D.

AU - Azzopardi, D.

AU - Berg, R.

AU - Boyle, David

AU - Boyle, R.

AU - Burchfield, D.

AU - Carlo, W.

AU - Chameides, L.

AU - Denson, S.

AU - Fallat, M.

AU - Gerardi, M.

AU - Gunn, A.

AU - Hazinski, M. F.

AU - Keenan, W.

AU - Knaebel, S.

AU - Milner, A.

AU - Perlman, J.

AU - Saugstad, O. D.

AU - Schleien, C.

AU - Solimano, A.

AU - Speer, M.

AU - Toce, S.

AU - Wiswell, T.

AU - Zaritsky, A.

PY - 2000/9

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N2 - The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: * Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. * Preventing heat loss: Hyperthermia should be avoided. * Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO(2) detection can be useful in the secondary confirmation of endotracheal intubation. * Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse. * Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available. * Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.

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