Resuscitation 95 (2015) 249–263

Contents lists available at ScienceDirect

Resuscitation
journal homepage:www.elsevier.com/locate/resuscitation

European Resuscitation Council Guidelines for Resuscitation 2015
Section 7. Resuscitation and support of transition of babies at birth
a,∗

b

Jonathan Wyllie
, Jos Bruinenberg , Charles Christoph Roehr
c
g
Daniele Trevisanuto , Berndt Urlesberger
a

d,e

Department of Neonatology, The James Cook University Hospital, Middlesbrough,
b
UK Department of Paediatrics, Sint Elisabeth Hospital, Tilburg, The Netherlands
c
Department of Women and Children’s’ Health, Padua University, Azienda Ospediliera di Padova, Padua, Italy
d
Department of Neonatology, Charité Universitätsmedizin, Berlin, Berlin, Germany
e
Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
f
Department of Neonatology, Medizinische Fakultät Carl Gustav Carus, TU Dresden,
g
Germany Division of Neonatology, Medical University Graz, Graz, Austria

f

, Mario Rüdiger ,

Introduction
The following guidelines for resuscitation at birth have been developed during the process that culminated in the 2015
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment
1,2

3

Recommendations (CoSTR, 2015).
They are an extension of the guidelines already published by the ERC and take
into account recommendations made by other national and international organisations and previously evaluated
4

evidence.

Summary of changes since 2010 guidelines
The following are the main changes that have been made to the guidelines for resuscitation at birth in 2015:
• Support of transition: Recognising the unique situation of the baby at birth, who rarely requires ‘resuscitation’ but
sometimes needs medical help during the process of postnatal transition. The term ‘support of transition’ has been
introduced to better distinguish between interventions that are needed to restore vital organ functions (resuscitation) or
to support transition.
• Cord clamping: For uncompromised babies, a delay in cord clamping of at least 1 min from the complete delivery of the
infant, is now recommended for term and preterm babies. As yet there is insufficient evidence to recommend an
appropriate time for clamping the cord in babies who require resuscitation at birth.

• Temperature: The temperature of newly born nonasphyxiated infants should be maintained between 36.5 C and 37.5
C after birth. The importance of achieving this has been highlighted and

Corresponding author.
E-mail address: jonathan.wyllie@stees.nhs.uk (J. Wyllie).

reinforced because of the strong association with mortality and morbidity. The admission temperature should be
recorded as a predictor of outcomes as well as a quality indicator.
Maintenance of temperature: At <32 weeks gestation, a combination of interventions may be required to maintain the

temperature between 36.5 C and 37.5 C after delivery through admission and stabilisation. These may include
warmed humidified respiratory gases, increased room temperature plus plastic wrapping of body and head, plus thermal
mattress or a thermal mattress alone, all of which have been effective in reducing hypothermia.

Optimal assessment of heart rate: It is suggested in babies requiring resuscitation that the ECG can be used to provide
a rapid and accurate estimation of heart rate.
Meconium: Tracheal intubation should not be routine in the presence of meconium and should only be performed for
suspected tracheal obstruction. The emphasis should be on initiating ventilation within the first minute of life in
nonbreathing or ineffectively breathing infants and this should not be delayed.
Air/Oxygen: Ventilatory support of term infants should start with air. For preterm infants, either air or a low concentration
of oxygen (up to 30%) should be used initially. If, despite effective ventilation, oxygenation (ideally guided by oximetry)
remains unacceptable, use of a higher concentration of oxygen should be considered.
Continuous Positive Airways Pressure (CPAP): Initial respiratory support of spontaneously breathing preterm infants
with respiratory distress may be provided by CPAP rather than intubation.

The guidelines that follow do not define the only way that resuscitation at birth should be achieved; they merely
represent a widely accepted view of how resuscitation at birth can be carried out both safely and effectively (Fig. 7.1).

http://dx.doi.org/10.1016/j.resuscitation.2015.07.029
0300-9572/© 2015 European Resuscitation Council. Published by Elsevier Ireland Ltd. All rights reserved.

breathing and heart rate If gasping or not breathing: .Maintain Temperature 250 J. Wyllie et al. / Resuscitation 95 (2015) 249–263 (Antenatal counselling) Team briefing and equipment check Birth Dry the baby Maintain normal temperature Start the clock or note the time Assess (tone).

Open the airway Give 5 inflation breaths Consider SpO2 ± ECG monitoring Reassess If no increase in heart rate look for chest movement If chest not moving: Recheck head position Consider 2-person airway control and other airway manoeuvres Repeat inflation breaths SpO2 monitoring ± ECG monitoring Look for a response 60 s Acceptable pre-ductal SpO2 2 min 60% 3 min 70% 4 min 80% 5 min 85% 10 min 90% When the chest is moving: If heart rate is not detectable or very slow (< 60 min-1) Start chest compressions Coordinate compressions with PPV (3:1) Reassess heart rate every 30 seconds If heart rate is not detectable Increase oxygen (Guidedby oximetry if available) If no increase in heart rate look for chest movement or very slow (< 60 min-1) consider venous access and drugs Discuss with parents and debrief team .

At All Times Ask: Do You Need Help? .

1. J. PPV: positive pressure ventilation.Fig. Wyllie et al. ECG: electrocardiograph. Newborn life support algorithm. / Resuscitation 95 (2015) 249–263 Preparation Planned home deliveries 251 . SpO2 : transcutaneous pulse oximetry. 7.

of 97. and cessation of the placental circulation bring about this transition. requires anatomic and physiological adjustments to achieve the conversion from placental gas exchange with intrauterine lungs filled with fluid. because of the distance from further assistance. 2% were intubated to support respiratory function and 0. However. Ideally. teaching the standards and skills required for resuscitation of the newborn is therefore essential for any institution or clinical area in which deliveries may occur. the overwhelming majority will require only assisted lung aeration. When a birth takes place in a nondesignated delivery area. the recommended minimum set of equipment includes a device for safe assisted lung aeration and subsequent ventilation of an appropriate size for the newborn. Continued experiential learning and practice is necessary to maintain skills.The fetal to neonatal transition. only 10 per 1000 (1%) 8 babies of 2. with other resuscitation equipment immediately available. A tiny minority may need a brief period of chest compressions in addition to lung aeration. the care of the baby should be their sole responsibility. therefore. All equipment must be regularly checked and tested. A structured educational programme. should not compromise the standard of initial assessment. about 2 per 1000 (0. to pulmonary respiration with aerated lungs. 5–7 However. Equipment and environment Unlike adult cardiopulmonary resuscitation (CPR). two trained professionals should be present at all home deliveries. babies delivering before 35 weeks gestation. but the decision to undergo a planned home delivery. Of these. approximately 3% initiated respirations following positive pressure ventilation. a sterile instrument for cutting and clamping the umbilical cord and clean gloves for the attendant and assistants. 90% responded to mask ventilation alone while the remaining 10% appeared not to respond to mask inflation and therefore were intubated at birth. responded to mask inflation of the lungs and only 2 per 1000 appeared to need intubation. .e. those born after 32 weeks gestation and following an apparently normal labour. stabilisation or resuscitation at birth. Should there be any need for intervention. personnel trained in newborn life support should be easily available for every delivery. based on current practice and clinical audit. resuscitation at birth is often a predictable event. Whenever there is sufficient time. draught free area with a flat resuscitation surface placed below a radiant heater (if in hospital). once agreed with medical and midwifery staff. specially trained personnel should be present with at least one person experienced in tracheal intubation. Unexpected deliveries outside hospital are most likely to involve emergency services that should plan for such events. maternal 9 infection and multiple pregnancies. the initiation of air breathing.1% received chest compressions and/or adrenaline. Resuscitation should take place in a warm. if no support is given. In a retrospective study.648 babies born in Sweden in one year. The absorption of lung fluid. might subsequently result in a need for resuscitation. There was almost no need for cardiac compressions. warm dry towels and blankets. the aeration of the lungs. elective caesarean delivery at term does not increase the risk of needing newborn resuscitation in the absence 14–17 of other risk factors. approximately 85% of babies born at term initiated spontaneous respirations within 10 to 30 s of birth. Local guidelines indicating who should attend deliveries should be developed. babies delivering vaginally by the breech.2%) appeared to need resuscitation or help with transition at delivery. an additional 10% responded during drying and stimulation. this is not always the case. well lit. It is also important to prepare the family in cases where it is likely that resuscitation might be required. caesarean delivery is associated with an increased risk of problems 10–13 with respiratory transition at birth requiring medical interventions especially for deliveries before 39 weeks gestation. Although it is sometimes possible to predict the need for resuscitation or stabilisation before a baby is born. and this must be made clear to the mother at the time plans for home delivery are made. Of those needing any help. Recommendations as to who should attend a planned home delivery vary from country to country. i. In deliveries with a known increased risk of problems. Most of those. one of these must be fully trained and experienced in providing mask ventilation and chest compressions in the newborn. Each institution should have a protocol in place for rapidly mobilising a team with competent resuscitation skills for any birth. but a few more have problems with this perinatal transition. A minority of infants require resuscitation at birth. Any newborn may potentially develop problems during birth. Furthermore. 8 per 1000. which. which occurs at the time of birth.5 kg or more appeared to need any resuscitation at delivery. Resuscitation or support of transition is more likely to be needed by babies with intrapartum evidence of significant fetal compromise. It is therefore possible to prepare the environment and the equipment before delivery of the baby. There will inevitably be some limitations to resuscitation of a newborn baby in the home. the team attending the delivery should be briefed before delivery and clear role assignment should be defined. The same study tried to assess the unexpected need for resuscitation at birth and found that for low risk babies.

22 They have also suggested greater 21 use of phototherapy for jaundice in the delayed group but this was not found in a randomised controlled trial.25 as well as of late onset sepsis. Experimental evidence from similarly treated lambs suggest the same holds true for premature newborn. including higher mean blood pressure and haemoglobin on admission. incidence of intraventricular haemorrhage and periventricular leukomalacia 23 Some studies have suggested a reduced 22.Timing of clamping the umbilical cord Cineradiographic studies of babies taking their first breath at delivery showed that those whose cords were clamped prior to this had an immediate decrease in the size of the heart during the subsequent three or four cardiac cycles. 21. 23 There were also fewer blood transfusions in the ensuing weeks. 19 20 Studies of delayed clamping have shown an improvement in iron status and a number of other haematological indices over the next 3–6 months and a reduced need for transfusion in preterm infants. compared to controls. 18 Brady et al drew attention to the occurrence of a bradycardia apparently induced by clamping the cord before the first breath and noted that this did not occur in babies where clamping occurred after breathing was established. The initial decrease in size could be interpreted as the significantly increased pulmonary blood flow following the decrease in pulmonary vascular resistance upon lung aeration.24. A systematic review on delayed cord clamping and cord milking in preterm infants found improved stability in the immediate postnatal period. as a consequence. The subsequent increase in size would. be caused by the blood returning to the heart from the lung. The heart then increased in size to almost the same size as the fetal heart. 24 .

Wyllie et al.252 J. / Resuscitation 95 (2015) 249–263 .

Dry the term baby immediately after delivery.105 associated with a progression of cerebral injury.27.No human studies have yet addressed the effect of delaying cord clamping on babies apparently needing resuscitation at birth because such babies have been excluded from previous studies.77.107 resuscitation.66.85 70.49 28%. may require a combination of further interventions to maintain the temperature ◦ ◦ between 36. (and Virginia Apgar herself found that heart rate was the most 106 important predictor of immediate outcome). and the admission temperature of newborn non asphyxiated infants is a strong predictor of 31–65 mortality at all gestations and in all settings.86.49. For each 1 C decrease in admission temperature below this range there is an associated increase in mortality by 1.70–74 31.55.5 C after ◦ birth. Infants born to febrile mothers have a higher incidence of perinatal respiratory depression. without drying the baby beforehand.81 • • If the baby needs support in transition or resuscitation then place the baby on a warm surface under a preheated radiant warmer.80 For babies less than 28 weeks gestation the delivery room temperature should be >25 ◦ C. repeated assessment particularly of heart rate and.74–79 49 support hypoglycaemia and in some studies late onset sepsis.94 Alternatively. 95–101 They should be covered and protected from draughts. The association between hypothermia and mortality has been known for 30 more than a century. Whilst maintenance of a baby’s temperature is important. can indicate whether the baby is responding or whether further efforts are needed.48. A similar delay should be applied to preterm babies not requiring immediate resuscitation after birth.79. which have all been effective in reducing hypothermia.35. Preterm infants are especially vulnerable and hypothermia is also 35.5 C after delivery through admission and stabilisation. 93.83 • • polyethylene wrapping. Umbilical cord milking may prove an alternative in these infants although there is 1. can identify babies needing resuscitation. Cover the head and body of the baby. However. ◦ ◦ The temperature of newly born non asphyxiated infants should be maintained between 36. this should be monitored in order to avoid hyperthermia ◦ (>38. neonatal seizures.72. In addition. Animal studies indicate that hyperthermia during or following ischaemia is 104. namely respiratory rate. Delaying umbilical cord clamping for at least 1 min is recommended for newborn infants not requiring resuscitation. Prevent heat loss: 80 52 • • Protect the baby from draughts. individual components of the score. with a warm and dry towel to prevent further heat loss. ◦ 1. place the baby skin to skin with mother and cover both with a towel. admission temperature and urine output when compared to delayed cord clamping (>30 s) in babies born by caesarean section. These may include warmed humidified 84. Until more evidence is available. 27 Compromised babies are particularly vulnerable.82. .0 C). although these differences were not observed in infants born 26 vaginally. babies <32 weeks gestation.5 C and 37. apart from the face. Umbilical cord milking produces improved short term haematological outcomes. Babies born unexpectedly outside a normal delivery environment may benefit from placement in a food grade plastic bag after drying and then swaddling. if assessed rapidly. Alternatively. to a lesser extent breathing.2 currently not enough evidence available to recommended this as a routine measure.37. Temperature control Naked.5 C and 37. Exposure of the newborn to cold stress will lower arterial oxygen 28 29 tension and increase metabolic acidosis. increased room temperature plus cap plus thermal mattress or thermal mattress 88–92 alone. infants who are not breathing or crying may require the umbilical cord to be clamped.42. 102. All babies less than 32 weeks gestation should have the head and body of the baby (apart from the face) covered with 73.2. and also placed under a radiant heater. Initial assessment The Apgar score was not designed to be assembled and ascribed in order to then identify babies in need of 106. Furthermore.2.87 respiratory gases. • Keep the delivery room warm at 23–25 C.66–69 associated with serious morbidities such as intraventricular haemorrhage need for respiratory 31. well newborns >30 weeks gestation may be dried and nursed with skin to skin contact or kangaroo mother care to maintain their temperature whilst they are transferred.103 early mortality and cerebral palsy.60. newborn babies cannot maintain their body temperature in a room that feels comfortably warm for adults. so that resuscitation measures can commence promptly. wet.48. Make certain windows closed and airconditioning appropriately programmed. heart rate and tone. The admission temperature should be recorded as a predictor of outcomes as well as a quality indicator.

evaluate the rate. Tone A very floppy baby is likely to be unconscious and will need ventilatory support. indicate hypoxaemia. Several studies have demonstrated that ECG is faster than pulse oximetry and more reliable. Persistent pallor despite ventilation may indicate significant acidosis or rarely hypovolaemia. Wyllie et al. Heart rate is initially most rapidly and accurately assessed by 108 109–112 listening to the apex beat with a stethoscope or by using an electrocardiograph. Although colour is a poor method of judging oxygenation. J. / Resuscitation 95 (2015) 249–263 253 . the use of ECG does not replace the need to use pulse oximetry to assess the newborn baby’s oxygenation. especially in the first 2 min after 110–115 birth. Heart rate Immediately after birth the heart rate is assessed to evaluate the condition of the baby and subsequently is the most sensitive indicator of a successful response to interventions. which is better assessed using pulse oximetry if possible. If so. A healthy baby is born blue but starts to become pink within 30 s of the onset of effective breathing.113 100 beats per minute (bpm) and clinical assessment may underestimate the heart rate.Breathing Check whether the baby is breathing. Peripheral cyanosis is common and does not. by itself. however. Feeling the pulse in the base of the umbilical cord is often effective but can be misleading because cord pulsation is only reliable if found to be more than 108 108. check preductal oxygenation with a pulse oximeter. it should not be ignored: if a baby appears blue. For babies requiring 111 resuscitation and/or continued respiratory support.109. a modern pulse oximeter can give an accurate heart rate. depth and symmetry of breathing together with any evidence of an abnormal breathing pattern such as gasping or grunting. Colour 116 Colour is a poor means of judging oxygenation.

Dry and wrap. pneumothorax. Newborn life support Commence newborn life support if initial assessment shows that the baby has failed to establish adequate regular −1 normal breathing. remain hypoxaemic. This baby will usually improve with mask inflation but if this does not increase the heart rate adequately. more complex interventions will be futile unless these two first steps have been successfully completed. It remains important to ensure the baby’s temperature is maintained. Preterm babies may be breathing and showing signs of respiratory distress in which case they should be supported initially with CPAP. (3) Breathing inadequately or apnoeic. or has a heart rate of less than 100 min (Fig.2. Fig. There is no need for immediate clamping of the cord. Once this has been successfully accomplished the baby may also need chest compressions. further support will be required. Normal or reduced tone. wrapping in a warm towel and. Low or undetectable heart rate. Often pale suggesting poor perfusion. lung inflation and ventilation. 7.Tactile stimulation Drying the baby usually produces enough stimulation to induce effective breathing. Heart rate higher than 100 min −1 . though breathing with a good heart rate. Good tone.1). diaphragmatic hernia or surfactant deficiency. may rarely also require ventilations. Heart rate less than 100 min −1 . where appropriate. and may be put to the breast at this stage.2). Classification according to initial assessment On the basis of the initial assessment. There remains a very rare group of babies who. Floppy. This baby requires no intervention other than drying. (2) Breathing inadequately or apnoeic. Avoid more vigorous methods of stimulation. If the baby fails to establish spontaneous and effective breaths following a brief period of stimulation. and perhaps drugs. congenital pneumonia. 117 . Furthermore. Newborn with head in neutral position. 7. The supine position for airway management is traditional but sidelying has also been used for assessment and routine delivery room management of term newborns but not for resuscitation. The baby will remain warm through skin to skin contact with mother under a cover. Opening the airway and aerating the lungs is usually all that is necessary. the baby can be placed into one of three groups: (1) Vigorous breathing or crying. 7. In floppy babies application of jaw thrust or the use of an appropriately sized oropharyngeal airway may be essential in opening the airway. Airway Place the baby on his or her back with the head in a neutral position (Fig. This baby will then require immediate airway control. This group includes a range of possible diagnoses such as cyanotic congenital heart disease. A 2 cm thickness of the blanket or towel placed under the baby’s shoulder may be helpful in maintaining proper head position. handing to the mother. Dry and wrap.

Suction is needed only if the airway is obstructed. Two multicentre randomised controlled trials showed that routine elective 126 intubation and tracheal suctioning of these infants.135 Initial breaths and assisted ventilation After initial steps at birth. In term babies. Tracheal intubation should not be 128–132 routine in the presence of meconium and should only be performed for suspected tracheal obstruction. viscous meconium in a nonvigorous baby is the only indication for initially considering visualising the oropharynx and suctioning material. The much less common finding of very thick meconium stained liquor at birth is an indicator of perinatal distress and should alert to the potential need for resuscitation. connected to a suction source not exceeding −150 mmHg. did not reduce MAS and that suctioning the nose and mouth of such babies on the perineum and before delivery of the shoulders (intrapartum suctioning) was 127 ineffective. However. 128 The presence of thick. or a paediatric Yankauer sucker. 122.125 other studies failed to find any evidence of benefit from this practice.3).118 There is no need to remove lung fluid from the oropharynx routinely. 7. lung aeration is the priority and must not be delayed (Fig. lung inflation is a 136 The primary measure of adequate initial . if vigorous at birth. respiratory support should start with air. thick tenacious mucus or vernix even in deliveries where meconium staining is not present.123 Furthermore 124. aggressive pharyngeal suction can delay the onset of spontaneous breathing and cause laryngeal spasm and vagal bradycardia. 133 The routine administration of surfactant or bronchial 134. which might obstruct the airway. A small RCT has recently demonstrated no difference in the incidence of MAS between patients receiving tracheal intubation followed by suctioning and those not intubated. However. Lightly meconium stained liquor is common and does not. if breathing efforts are absent or inadequate. Hence intrapartum suctioning and routine intubation and suctioning of vigorous infants born through meconium stained liquor are not recommended. If suctioning is attempted use a 12–14 FG suction catheter. studies supporting this view were based on a comparison of suctioning on the outcome of a group of babies with the outcome of historical controls. in general. give rise to much difficulty with transition. 119–121 Meconium For over 30 years it was hoped that clearing meconium from the airway of babies at birth would reduce the incidence and severity of meconium aspiration syndrome (MAS). lavage with either saline or surfactant is not recommended. Obstruction may be caused by particulate meconium but can also be caused by blood clots. The emphasis should be on initiating ventilation within the first minute of life in nonbreathing or ineffectively breathing infants and this should not be delayed.

Wyllie et al.254 J. / Resuscitation 95 (2015) 249–263 .

This will usually help lung 137. Efficacy of the intervention can be estimated by a prompt increase in heart rate or observing the chest rise. Without adequate lung aeration.141. 145 Alternatively using a two person approach to mask ventilation reduces mask leak in term and 146. until there is adequate spontaneous breathing. confirm lung aeration and ventilation before progressing to circulatory support. if these are present then lung aeration has been achieved. Mask ventilation of newborn. 149 145– In this case. If these are absent then airway control and lung aeration has not been confirmed. 7.142 expansion. Most babies needing respiratory support at birth will respond with a rapid increase in heart rate within 30 s of lung inflation. If the heart rate increases but the baby is not breathing adequately. Adequate passive ventilation is usually indicated by either a rapidly increasing heart rate or a heart rate that is −1 maintained faster than 100 beats min . Continue ventilatory support until the baby has established normal regular breathing. If this is not obtained it is likely that repositioning of the airway or mask will be required and. In term infants. Mask leak.9 kPa) with a mean of 20 cm H 2 O. rarely. ventilate at a rate of about 30 breaths −1 min allowing approximately 1 s for each inflation. therefore. inflation time and flow required to establish an effective FRC has not been determined. but this requires training and experience.142 cm H2 O (1.Fig. higher inspiratory pressures may be needed. Look for passive chest movement in time with inflation efforts. are all possible reasons. The optimum pressure. prompt improvement in heart rate. If the baby does not respond in this way the most likely cause is inadequate airway control or inadequate ventilation. The pressure required to aerate the fluid filled lungs of newborn babies requiring resuscitation is 15–30 137.5–2. chest compressions will be ineffective. reevaluate the airway position and deliver inflation breaths while summoning a colleague with intubation skills. which may need correction.147 preterm infants. inappropriate airway position and airway obstruction. consider repositioning the mask to correct for leakage and/or reposition the baby’s head to correct for airway obstruction. 137–141 spontaneous or assisted initial inflations create a functional residual capacity (FRC). . If the heart rate is not improving assess the chest wall movement. Some practitioners will ensure airway control by tracheal intubation.3. For the first five positive pressure inflations maintain the initial inflation pressure for 2–3 s. For term babies use an inflation pressure of 30 cm H 2 O 143. If this skill is not available and the heart rate is decreasing.144 and 20–25 cm H2 O in preterm babies.

166 159.2.166 or retinopathy of prematurity. they should be weaned as soon as possible. 156.165. 157 Sustained inflations (SI) > 5 s Several animal studies have suggested that a longer SI may be beneficial for establishing functional residual capacity at birth during transition from a fluidfilled to airfilled lung. the high concentration was not associated with any improvement in survival. Modern pulse oximetery.155 150. / Resuscitation 95 (2015) 249–263 A reliable 255 . 144 However. 159. or air leak. if increased oxygen concentrations are used 136. using neonatal probes.162. details of the most appropriate length and pressure of inflation.162. Oxygen saturations (3rd. 158 therefore. Resuscitation of preterm infants less than 35 weeks gestation at birth should be initiated in air or low 1. If. 50th.164–166 intraventricular haemorrhage increase in markers of oxidative stress.159 Preterm babies. 7. 7.151 152– Review of the literature in 2015 disclosed three RCTs which demonstrated that initial SI reduced the need for mechanical ventilation. The administered oxygen concentration should be titrated to achieve acceptable preductal oxygen saturations approximating to the 25th percentile in healthy term babies immediately after 156. In a meta analysis of seven randomized trials comparing initiation of resuscitation with high (>65%) or low (21–30%) oxygen 159. 1. 7. 10th.4). to suggest routine application of SI of greater than 5 s duration to the transitioning newborn. 154 and two cohort studies. provides reliable readings of heart rate and 167.162. It was the consensus of the COSTR reviewers that there was inadequate study of the safety. 159.Fig. One cohort study suggested that the need for intubation was less following SI.161–166 concentrations.157 High concentrations of oxygen are associated with an increased mortality and delay in time of onset of spontaneous breathing. 25th.160 concentration oxygen (21–30%).4. bronchopulmonary dysplasia. Reproduced with permission from. despite effective ventilation. there is no increase in heart rate or oxygenation (guided by oximetry wherever possible) remains unacceptable. use a higher concentration of oxygen to achieve an adequate preductal oxygen saturation. There was an 159 Pulse oximetry.4). and longterm effects. should only be considered in individual clinical circumstances or in a research setting. In term infants receiving respiratory support at birth with positive pressure ventilation (PPV). Wyllie et al. and 97th SpO 2 percentiles) in healthy infants at birth without medical intervention. bronchopulmonary dysplasia.2 Sustained inflations >5 s Air/Oxygen Term babies. no benefit was found for reduction of mortality. 90th. 144.157 birth (Fig. 75th. it is best to begin with air (21%) as opposed to 100% oxygen.136.168 transcutaneous oxygen saturation within 1–2 min of birth (Fig. J.

200 .192–195 196 Respiratory function monitors measuring inspiratory pressures and tidal volumes and exhaled carbon dioxide 197. Values are lower in those born by Caesarean delivery. approximately 80% of those born preterm.1 and 7.187 generated may exceed the value specified by the manufacturer if compressed vigorously. Two randomised To avoid this some institutions are using nasopharyngeal prongs to deliver respiratory Table 1 Oral tracheal tube lengths by gestation. Pulse oximetry should be used to avoid excessive use of oxygen as well as to direct its judicious use ( Figs. a selfinflating bag or with a T-piece mechanical device designed to regulate pressure. Laryngeal mask airway 199.g. compliance and gas exchange.4). Uncompromised babies born at term at sea level 169 156 have SpO2 ∼60% during labour. and 80167 90% of those apparently requiring resuscitation. Transcutaneous oxygen saturations above the acceptable levels should prompt weaning of any supplemental oxygen. Face mask versus nasal prong A reported problem of using the facemask for newborn ventilation is mask leak caused by a failure of the seal between 145–148 the mask and the face. nasal airways.preductal reading can be obtained from >90% of normal term births. a flowinflating bag or a T-piece mechanical device. However. It is suggested that positive end expiratory pressure (PEEP) of ∼5 cm H2 O should be administered to 173 preterm newborn babies receiving PPV. 174 Animal studies show that preterm lungs are easily damaged by large volume inflations immediately after birth and 175. those born at 171 172 157 altitude and those managed with delayed cord clamping. selfinflating bags are the only devices. 7. support. all designed to regulate pressure or limit pressure applied to the airway can be used to ventilate a newborn. within 2 min of birth. need for resuscitation or bronchopulmonary dysplasia they were 181.176 suggest that maintaining a PEEP immediately after birth may protect against lung damage although some evidence 177 178–180 suggests no benefit. nor risks attributed to their use have so far been identified. However.182 underpowered for these outcomes. which increases to >90% by 10 min. Two human newborn RCTs demonstrated no improvement in mortality. Those born preterm may take longer to reach >90%. Gestation (weeks) ETT at lips (cm) 23–24 25–26 27–29 30–32 33–34 35–37 38–40 5·5 6·0 6·5 7·0 7·5 8·0 8·5 41–43 9·0 trials in preterm infants have compared the efficacy and did not find any difference between the methods.198 monitors to assess ventilation have been used but there is no evidence that they affect outcomes. The 25th percentile is approximately 40% at 157 170 birth and increases to ∼80% at 10 min. laryngeal masks) during PPV in the delivery room has not been reported. tidal volumes and long inspiratory times are achieved more consistently in mechanical models when using Tpiece devices than when using bags. which can be used in the absence of compressed gas but cannot deliver continuous positive airway pressure (CPAP) and may not be able to achieve PEEP even with a PEEP valve in place 189. 187–190 although the clinical implications are not clear. 181–185 The blow-off valves of selfinflating bags are flowdependent and pressures 186. More training is required to 191 provide an appropriate pressure using flowinflating bags compared with selfinflating bags. Positive end expiratory pressure All term and preterm babies who remain apnoeic despite initial steps must receive positive pressure ventilation after initial lung inflation. Neither additional benefit above clinical assessment alone. PEEP also improves lung aeration. Target inflation pressures. A selfinflating bag. The use of exhaled CO2 detectors to assess ventilation with other interfaces (e. one of the trials suggested that PEEP reduced the amount of 182 supplementary oxygen required. Assisted ventilation devices Effective ventilation can be achieved with a flowinflating..

as 208 marked on tracheal tubes by different manufacturers to aid correct placement. Exhaled CO2 detection is effective for confirmation of tracheal tube placement in infants. • Special circumstances (e.212 210 suggests oesophageal intubation but false negative readings have been reported during cardiac arrest and in VLBW infants .g. Tracheal tube placement must be assessed visually during intubation. The laryngeal mask airway has not been evaluated in the setting of meconium stained fluid. The LMA is recommended during resuscitation of term and preterm newborns ≥34 weeks gestation when tracheal intubation is unsuccessful or not feasible. It should be recognised that vocal cord guides. When. vary considerably. The laryngeal mask airway may be considered as an alternative to tracheal intubation as a secondary 201–206 airway for resuscitation among newborns weighing more than 2000 g or delivered ≥34 weeks gestation. or for the administration of emergency intratracheal medications. during chest compressions.. particularly if facemask ventilation is unsuccessful or tracheal intubation is unsuccessful or not feasible. after correction of mask technique and/or the baby’s head position. and positioning confirmed. a prompt increase in heart rate is a good indication that the tube is in the 209 tracheobronchial tree. Tracheal tube placement Tracheal intubation may be considered at several points during neonatal resuscitation: • • • When suctioning the lower airways to remove a presumed tracheal blockage. congenital diaphragmatic hernia or to give tracheal surfactant). however. to evaluate its use for newborns weighing <2000 gram or delivered <34 weeks gestation. 210–213 including VLBW infants and neonatal studies suggest that it confirms tracheal intubation in neonates with a cardiac 212–214 output more rapidly and more accurately than clinical assessment alone. One recent unblinded RCT demonstrated that following training with one type of LMA. The LMA may be considered as an alternative to a facemask for positive pressure ventilation among newborns weighing more than 2000 g or delivered ≥34 weeks 201 gestation.The laryngeal mask airway can be used in resuscitation of the newborn. its use was associated with less tracheal intubation and neonatal unit admission in comparison to those receiving ventilation via a 201 facemask. The use and timing of tracheal intubation will depend on the skill and experience of the available resuscitators. Following tracheal intubation and intermittent positive pressure. bagmask ventilation is ineffective or prolonged. There is limited evidence. When chest compressions are performed. Failure to detect exhaled CO 2 strongly 210. 207 Appropriate tube lengths based on gestation are shown in Table 1.

Wyllie et al. / Resuscitation 95 (2015) 249–263 .256 J.

Use a 3:1 compression to ventilation ratio. i. neonatal studies have excluded infants in need of extensive resuscitation. This technique generates higher blood 222–234 pressures and coronary artery perfusion with less fatigue than the previously used two finger technique. A 3:1 compression to ventilation ratio is used for resuscitation at birth where compromise of gas exchange is nearly always the primary cause of cardiovascular collapse. False positives may occur with colorimetric devices contaminated with adrenaline (epinephrine). but rescuers may consider using higher ratios (e. rather than intubation. the steps of trying to achieve return of spontaneous circulation using effective ventilation with low .220 Circulatory support Circulatory support with chest compressions is effective only if the lungs have first been successfully inflated. inability to detect exhaled CO 2 despite correct placement may lead to unnecessary extubation. 7. aiming to achieve approximately 120 events per minute. However.e. 247 However. surfactant 198 and atropine. Poor or absent pulmonary blood flow or tracheal obstruction may prevent detection of exhaled CO 2 despite correct tracheal tube placement. 216–218 CPAP in term infants at birth and further clinical studies are required. Detection of exhaled carbon dioxide in addition to clinical assessment is recommended as the most reliable method to confirm tracheal placement in neonates with spontaneous circulation. the quality of the compressions and breaths are probably more 248 important than the rate. As ventilation is the most effective and important intervention in newborn resuscitation. 241–246 There are theoretical advantages to allowing a relaxation phase that is very slightly longer than the compression phase. The most effective technique for providing chest compressions is with two thumbs over the lower third of the sternum 221–224 with the fingers encircling the torso and supporting the back (Fig. 15:2) if the arrest is believed to be of cardiac origin. in critically ill infants with poor cardiac output. Other clinical indicators of correct tracheal tube placement include evaluation of condensed humidified gas during exhalation and presence or absence of chest movement. In a manikin study overlapping the thumbs on the sternum was more effective than positioning them adjacent but more likely to cause fatigue. There are few data to guide the appropriate use of 219. but these have not been evaluated systematically in newborn babies.4 CPAP Initial respiratory support of all spontaneously breathing preterm infants with respiratory distress may be provided by CPAP. Tracheal tube placement is identified correctly in nearly all patients who are not in cardiac 211 arrest .215 despite models suggesting efficacy. Three RCTs enrolling 2358 infants born at <30 weeks gestation demonstrated that CPAP is beneficial when compared to initial tracheal ventilation and PPV in reducing the rate of intubation and duration of mechanical ventilation without any short term disadvantages. 235 The sternum is compressed to a depth of approximately one third of the anterior posterior diameter of 225. Give −1 chest compressions if the heart rate is less than 60 beats min despite adequate ventilation.5). Compressions and ventilations should be coordinated to avoid simultaneous delivery. 3. and may be compromised by compressions. however.g. When resuscitation of a newborn baby has reached the stage of chest compressions.. it is vital to ensure that effective ventilation is occurring before commencing chest compressions.236–240 the chest allowing the chest wall to return to its relaxed position between compressions. approximately 90 compressions and 30 ventilations.

and establishing adequate ventilation is the most important step to −1 correct it. it would appear sensible to try increasing the supplementary oxygen concentration towards 100%. Discontinue chest compressions when the −1 spontaneous heart rate is faster than 60 beats min . 256–260 .2 Drugs Drugs are rarely indicated in resuscitation of the newly born infant. 7. There are no human studies to support this and animal studies demonstrate no 249–255 advantage to 100% oxygen during CPR. 7. current evidence does not 1. Thus. Adrenaline Despite the lack of human data it is reasonable to use adrenaline when adequate ventilation and chest compressions have failed to increase the heart rate above 60 beats min −1 . if the heart rate remains less than 60 beats min despite adequate ventilation and chest compressions. Exhaled carbon dioxide monitoring and pulse oximetry have been reported to be useful in determining the return of spontaneous circulation support the use of any single feedback device in a clinical setting. it is reasonable to consider the use of drugs. Newborn umbilical cord showing the arteries and veins.6. concentration oxygen should have been attempted. Bradycardia in the newborn infant is usually caused by inadequate lung inflation or profound hypoxia. Wyllie et al. 7. If 1 umbilical vein 2 umbilical arteries LEGS Fig. These are best given via a centrally positioned umbilical venous catheter (Fig.6). however.5. However. Ventilation and chest compression of newborn.Fig. / Resuscitation 95 (2015) 249–263 HEAD 257 . J. Check the heart rate after about 30 s and periodically thereafter.

where withholding resuscitation 38. the potential reversibility of the situation.adrenaline is used. particularly when there has been the opportunity for discussion with parents. When resuscitating preterm infants volume is rarely needed and has been associated with intraventricular and pulmonary haemorrhages when large volumes are infused rapidly. There are insufficient data to recommend routine use of bicarbonate in resuscitation of the newly born. Bicarbonate If effective spontaneous cardiac output is not restored despite adequate ventilation and adequate chest compressions. In the absence of suitable blood (i.1 ml kg −1 of 1:10. The following guidelines must be interpreted according to current regional outcomes. 268 Opinions vary amongst providers. A recent study suggests that the institutional approach at the border of viability affects the subsequent results in surviving infants.4 −1 (0. parents and societies about the balance of benefits and 269. Social science studies indicate that parents desire a larger role in decisions to resuscitate and to continue life support in severely compromised babies. .261–265 required. Withholding resuscitation and discontinuation of life sustaining treatment during or following resuscitation are considered by many to be ethically equivalent and clinicians should not be hesitant to withdraw support when the possibility of functional survival is highly unlikely. Give a bolus of 10 ml kg initially.277–282 may be considered reasonable. Use of sodium bicarbonate is not recommended during brief CPR.000 adrenaline) should be administered with subsequent intravenous doses of 10–30 micrograms kg −1 (0. 1.7. If the heart rate of a newly born baby is not detectable and remains undetectable for 10 min. the gestation of the baby. If successful it may need to be repeated to maintain an improvement. Local survival and outcome data are important in appropriate counselling of parents. the availability of therapeutic hypothermia and the parents’ previous expressed feelings about 267. an initial dose 10 micrograms kg intravenously as soon as possible 1:10.000 adrenaline) if required. In this situation there is insufficient evidence about outcome to enable firm guidance on whether to withhold or to continue resuscitation.3 ml kg −1 of −1 The tracheal route is not recommended but if it is used. The decision to continue resuscitation efforts when the heart rate has been undetectable for longer than 10 min is often complex and may be influenced by issues such as the presumed aetiology.e. it should be given only after adequate ventilation and circulation is established with CPR. Withholding resuscitation It is possible to identify conditions associated with high mortality and poor outcome. The hyperosmolarity and carbon dioxide generating properties of sodium bicarbonate may impair myocardial and cerebral function. it may be appropriate to consider stopping resuscitation.270 disadvantages of using aggressive therapies in such babies. 60 min −1 The decision should be individualised.1–0. Neither the safety nor the efficacy of these higher tracheal doses has been studied. reversing intracardiac acidosis may improve myocardial function and achieve a spontaneous circulation.2. A consistent and coordinated approach to individual cases by the obstetric and neonatal teams and the parents is an 283 important goal. This is a rare event. If it is used during prolonged arrests unresponsive to other therapy. poor perfusion. There is no evidence to support the prospective use of any particular delivery room prognostic score presently described. weak pulse) and has 266 not responded adequately to other resuscitative measures then consider giving fluid. In cases where the heart rate is less than at birth and does not improve after 10 or 15 min of continuous and apparently adequate resuscitative efforts. Do not give these high doses intravenously.272. in preterm infants <25 weeks gestation.272–276 acceptable risk of morbidity. −1 may be Fluids If there has been suspected blood loss or the infant appears to be in shock (pale. 271 Discontinuing resuscitation Local and national committees will define recommendations for stopping resuscitation. it is highly likely that doses of 50–100 micrograms kg will be 3. isotonic crystalloid rather −1 than albumin is the solution of choice for restoring intravascular volume. A dose of 1–2 mmol kg given by slow intravenous injection after adequate ventilation and perfusion have been established. the choice is much less clear. over gestational age assessment alone. irradiated and leucocyte depleted group O Rh negative blood). Withholding or discontinuing resuscitation 267 Mortality and morbidity for newborns varies according to region and to availability of resources.136.

without coercion or pressure. and anomalies such as anencephaly and confirmed Trisomy 13 or 18. adhere to the routine local plan and. hand the baby to the mother at the earliest opportunity. resuscitation is not indicated. ask questions about details of the resuscitation and be informed about the support services available. Resuscitation is nearly always indicated in conditions associated with a high survival rate and acceptable morbidity. birth weight. Finally. 286 The members of the resuscitation team and family members. At delivery. If resuscitation is required inform the parents of the procedures undertaken and why they were required. and/or congenital anomalies are associated with almost certain early death. if possible.284 283 Communication with the parents It is important that the team caring for the newborn baby informs the parents of the baby’s progress. 285 European guidelines are supportive of family presence during cardiopulmonary resuscitation. 286 .277. This will generally include babies with gestational age of 25 weeks or above (unless there is evidence of fetal compromise such as intrauterine infection or hypoxia ischaemia) and those with most congenital malformations. In recent years healthcare professionals are increasingly offering family members the opportunity to remain present during CPR and this is more likely if resuscitation takes place within the delivery room. and • • unacceptably high morbidity is likely among the rare survivors. 38. Examples from the published literature include: extreme prematurity (gestational age less than 23 weeks and/or birth weight less than 400 g). When withdrawing or withholding resuscitation. In conditions associated with uncertain prognosis. • and where the anticipated burden to the child is high. It is recommended to provide a healthcare professional whose sole responsibility is to care for the family member. Parents’ wishes to be present during resuscitation should be supported where possible. make the decision about who should be present during resuscitation jointly.• Where gestation. Whilst this may not always be possible it should not mean the exclusion of the family member from the resuscitation. parental desires regarding resuscitation should be supported. care should be focused on the comfort and dignity of the baby and family. where there is borderline survival and a relatively high rate of morbidity. there should be an opportunity for the immediate relative to reflect.

Wyllie et al.258 J. / Resuscitation 95 (2015) 249–263 .

Animal data would strongly suggest that the effectiveness of cooling is related to early intervention. midwives. These are partly explained by a lack of agreement on how to score infants receiving medical interventions or being born preterm.Decisions to discontinue resuscitation should ideally involve senior paediatric staff. There is no evidence in human newborns that cooling is effective if started more than 6 h after birth. Post resuscitation care Babies who have required resuscitation may later deteriorate. where possible. the range of blood glucose concentration that is associated with the least brain injury following asphyxia and resuscitation cannot be defined based on available evidence. Carefully monitor for known adverse effects of cooling such as thrombocytopenia and hypotension. clear classification or grading of newborn infants” to be used “as a basis for discussion and comparison of the results of obstetric practices. commence within 6 h of birth. One clinical study demonstrated an 290 association between hypoglycaemia and poor neurological outcome following perinatal asphyxia. In adults. many of these have been following simulation training. Therefore a development of the score was recommended as follows: all parameters are scored according to the conditions regardless of the interventions needed to achieve the condition and considering whether being appropriate for gestational age. This Combined Apgar has been shown to predict outcome in preterm and term infants better than the conventional score. its applicability has been questioned due to large inter and intraobserver variations. Treatment should be consistent with the protocols used in the randomized clinical trials (i. Record carefully all discussions and decisions in the mother’s notes prior to delivery and in the baby’s records after birth.303. Commencing cooling treatment >6 h after birth is at the discretion of the treating team and should only be on an individualised basis. Studies of the effect of briefings or 305–310 debriefings following resuscitation have generally shown improved subsequent performance. continue for 72 h of birth and rewarm over at least 4 h). hyperglycaemia has been associated with a worse 288–292 outcome. Induced hypothermia Newly born infants born at term or nearterm with evolving moderate to severe hypoxic ischemic encephalopathy 296–301 should. 311 A structured analysis of perinatal management with . obstetricians and birth attendants before 283 delivery. which confirms data from animal studies some of which suggest it may be protective. for example in the case of severe congenital malformation. be offered therapeutic hypothermia. the infant should be maintained in or transferred to an environment in which close monitoring and anticipatory care can be provided. the decision to attempt resuscitation of an extremely preterm baby should be taken in close consultation with the parents and senior paediatric and obstetric staff. for research purposes and as a prognostic 302 tool. In addition. Glucose Hypoglycaemia was associated with adverse neurological outcome in a neonatal animal model of asphyxia and 287 resuscitation. in paediatric patients. Once adequate ventilation and circulation are established. types of maternal pain relief and the effects of resuscitation” (our emphasis). A method that seems to further improve the management in the delivery room is videotaping and subsequent analysis of the videos. Prognostic tools The Apgar score was proposed as a “simple. common. hyperglycaemia after hypoxiaischaemia does not appear to be 293 294 295 harmful.e. 106 Although widely used in clinical practice.304 Briefing/debriefing Prior to resuscitation it is important to discuss the responsibilities of each member of the team. However. All treated infants should be followed longitudinally. Infants who require significant resuscitation should be monitored and treated to maintain glucose in the normal range. After the management in the delivery room a team debrief of the event using positive and constructive critique techniques should be conducted and personal bereavement counselling offered to those with a particular need. children and extremely low birth weight infants receiving intensive care. Where a difficulty has been foreseen. However. However. Whole body cooling and selective head cooling are both appropriate strategies. discuss the options and prognosis with the parents.289 areas of cerebral infarction and/or decreased survival compared to controls. Whenever possible. Cooling should be initiated and conducted under clearly defined protocols with treatment in neonatal intensive care facilities and with the capabilities for multidisciplinary care. the interventions needed to achieve the condition have to be scored as well. Newborn animals that were hypoglycaemic at the time of an anoxic or hypoxic ischemic insult had larger 288.

Ersdal HL. 4. 312 Regardless of the outcome. Arch Pediatr Adolesc Med 1995. Resuscitation 2010. Perlman JM. Wyllie J. Svensen E. Every opportunity should be taken to prepare parents for the possibility of a resuscitative effort when it is anticipated and to keep them informed as much as possible during and certainly after the resuscitation. 2.83:869–73. References 1. Resuscitation 2010. reducing the incidence of intraventricular haemorrhage in preterm infants. Conflicts of interest Jonathan Wyllie Berndt Urlesberger Charles Christoph Roehr Daniele Trevisanuto Jos Bruinenberg Mario Rüdiger No conflict of interest reported No conflict of interest reported Educational grant Fischer&Paykel and Medical advisor STEPHAN company No conflict of interest reported No conflict of interest reported Speakers honorarium Chiesi. Perlman JM. Early contact between parents and their baby is important. Kattwinkel J.81:1389–99. et al. J. Wyllie J. Perlman JM. Wyllie et al. Wyllie J. Resuscitation of babies at birth.81:Se260–87 [Suppl 1]. Richmond S. 3. 6. Part 11: Neonatal resuscitation: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. witnessing the resuscitation of their baby may be distressing for parents. European resuscitation council guidelines for resus-citation 2010 section 7.95:e171–203. Risser R. 5. Early initiation of basic resuscita-tion interventions including face mask ventilation may reduce birth asphyxia related mortality in low-income countries: a prospective descriptive observa-tional study. Cardiopulmonary resuscitation in the delivery room: associated clinical events. information should be given by a senior clinician. et al. Kattwinkel J.149:20–5. / Resuscitation 95 (2015) 249–263 259 . Part 7: Neonatal resuscitation: 2015 international consensus on cardiopulmonary resuscitation and emergency car-diovascular care science with treatment recommendations.feedback has been shown to improve outcomes. In press. Perlman JM. Lyomark and Research grant SLE device Acknowledgements The Writing Group acknowledges the significant contributions to this chapter by the late Sam Richmond. Mduma E. Kattwinkel J. Circulation. Part 7: Neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Whenever possible. Wyllie J. Resuscitation 2012. Resuscitation 2015. et al. Perlman JM.

Costeloe K. Ballot D. Mortality in out-of-hospital premature births. Jones P. Silverman WA. Chiosi C. Batra D.59:447–52. Lee HC. Jule L. Lacroze V. Diaz-Rossello J. Kilic S. 29. J Pediatr 1970. James LS. 34. Mock DM. The feeding and hygiene of premature and full-term infants. 13. An Pediatr (Barc) 2014. Neonatal hypothermia levels and risk factors for mortality in a tropical country. BMJ 2012. J Paediatr Child Health 2008. Association between hypothermia and mortality rate of premature infants—revisited.and short-term outcomes. 36. Polglase GR.24:307–15. 161A:2122–3. 42. 8. Watkinson M. Budin P [Translation by WJ Maloney] The nursling. Simeoni U.100:181–7. controlled trial. Genetic drift. 37. Atay V. Badr-El Din MM. 48. Riskin A. controlled study. Dawson JA. Br J Obstet Gynaecol 1991. Bhaskar B. et al. Yee W. Annibale DJ. et al. Kluckow M. Nolan T. 1907. Attendance of paediatricians at elective caesarean sections performed under regional anaesthesia: is it warranted? J Paediatr Child Health 2006. Transfusion 2014.164:111–2. Transfusion 2008. Parsons SJ. 31. Comparative neonatal mor-bidity of abdominal and vaginal deliveries after uncomplicated pregnancies. Brady JP. Sonneveld S. J Matern Fetal Neonatal Med 2013. Bhoopalam PS. de Arruda Vidal S. Is a paediatrician needed at all caesarean sections? J Paediatr Child Health 1998. Oshiro B. PloS One 2015. James LS. Marlow N. delivery. Determinants of death among admissions to intensive care unit for newborns. 10. Daga SR. 45.193:599–605. Am J Med Genet A 2013. 11. Abd-El Hamid S. Rivero Rodriguez S. Pediatrics 2006. Jeffery H. 20. et al. 35. Newborn temperature and calculated heat loss in the deliv-ery room. Outcome of unattended out-of-hospital births in Harlem. Pediatrics 2000. Umbilical cord milking versus delayed cord clamping in preterm infants. 17. Chessex P. Du JTKO. Arch Pediatr Adolesc Med 1995. Buetow KC. 18. Draper ES. Wales. Immediate versus delayed umbilical cord clamping in premature neonates born <35 weeks: a prospective. Ho QT. 16. Nicholas SW. Hazan J. Hypothermia on admission: a risk factor for death in newborns referred to the Pernambuco Institute of Mother And Child Health. Laptook AR. and Northern Ireland.118:1028–34. Harms K. Wood S. Goncalves de Mello MJ. Reynolds G. Pediatrics 2005. Babies born before arrival at hospital. Ventilation onset prior to umbili-cal cord clamping (physiological-based cord clamping) improves systemic and cerebral oxygenation in preterm lambs. McIntosh N. 23. Mungen E. and the immediate neonatal period.116:1457–65. London: The Caxton Publishing Company. Heart rate changes in the fetus and newborn infant dur-ing labor. J Trop Pediatr 2003. Pediatrics 2006. 12. 27. Pediatrics 2015.81:739–44.48:658–65. J Egypt Public Health Assoc 2012. Z Geburtshilfe Perinatol 1994. Wallach M. et al. et al. 46. McKechnie EJ.76:848–52. Cunningham N. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). 28. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. 9.117:1235–42.39:105–12.34:241–4. Kalimba E. Pediatric presence at cesarean section: justified or not? Am J Obstet Gynecol 2005. Kambarami R. Kugelman A. Acta Paediatr 2011. Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room. Osmers R. O’Bryan L. Rhine WD. 41. 26. 47. Am J Obstet Gynecol 1962. Saad KM. Garcia-Munoz Rodrigo F. Kelein SW.164:e1271–5. Mansfield P.198:126–33. Wilkinson AR.87:104–8. Thermal environment and acid-base homeostasis in human infants during the first few hours of life. de Almeida MF. 39. Mercer JS. Am J Perinatol 2007. Williams J. Strauss RG.7:13–6.80:144–50.Aziz K. Borenstein-Levin L. Wyckoff MH. Gun I. Costeloe KL. 30.149:862–7. 21. Wagner CL. Elective cesarean delivery.119:e643–9. S Afr J Child Health 2013.79:444–52. Patole SK. Admis-sion hypothermia among VLBW infants in Malaysian NICUs. 50. Eur J Pediatr 1981. Katheria AC. et al. Neonatology 2008. Courbiere B. Hospital deliveries.Palme-Kilander C. Maag U. da Mota Silveira SM. Effects of placental transfusion in extremely low birthweight infants: meta-analysis of long. Pediatrics 1972. Malaysian National Neonatal Registry. J Perinatol: Off J California Perinat Assoc 2008. A quality improvement project to improve admis-sion temperatures in very low birth weight infants. Bateman DA. Siles Quesada C.106:659–71. 14. Arch Pediatr Adolesc Med 1994. Gibson AT. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized. Padbury JF. Salhab W. Rabe H. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Chidede O.42:332–6.49:115–20.26:176–82. . Dabous NI. 25. J Obstet Gynaecol Res 2013. 22. Cent Afr J Med 2003. Methods of resuscitation in low-Apgar-score newborn infants—a national survey. Truong G. Alberti C. Finer NN. Effect of the use of a polyethylene wrap on the morbidity and mortality of very low birth weight infants in Alexandria University Children’s Hospital. et al. 15. Hennessy E. Stacey F. Daga AS. Guidicelli B. 38. Guat-Sim Cheah I.137:141–6. and neonatal respiratory distress.44:325–31.345:e7976. 43. Pediatrics 1964. Pediatrics 2007.54:1192–8. Amin H. Atherton N. 24. Haider S. Ertugrul S. Berthelot-Ricou A. Kent AL. Ghavam S. Guinsburg R. Mercer J. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. randomized.43:751–8. Johnson KJ. McGrath MM. Southgate WM. Resuscitation 2008.111:823–8. Muhcu M. Peltonen T. Dahm LS. 32. 33. J Clin Invest 1964. Placental transfusion—advantage an disadvantage. Adamsons Jr K. Boo NY. Baker M. Gandy GM. J Trop Pediatr 2013. Ante. Obstet Gynecol 2008. neonatal intensive care unit admission.49:103–6.and intra-partum fac-tors that predict increased need for neonatal resuscitation. Parsons SJ. Hennessy EM. Elbourne D.7.Barber CA. Andrews W. et al. de Frias PG. Project 27/28: inquiry into quality of neonatal care and its effect on the survival of infants who were born at 27 and 28 weeks in England. Mortality of premature infants 1980–1990: analysis of data from the Gottingen perinatal center. Effects of maintenenance of “normal” skin temperature on survival of infants of low birth weight. Sancho GA. J Pediatr 2014. Stephenson J.98:57–64. Chadwick M. Heagarty MC.37:53–6.49:504–13. The effect if cooling on blood gas tensions in newborn infants. Vohr BR. Gamerre M. Oh W. James LS. Respiratory distress syndrome after elective caesarean section in near term infants: a 5-year cohort study. 44.148:147–52. Kron M. 49. Hypothermia and early neonatal mortality in preterm infants.84:1–12.28:754–8.10:e0117504. Hypothermia risk factors in the very low weight newborn and associated morbidity and mortality in a neonatal care unit. Acta Paediatr 1992. Admission tem-perature of low birth weight infants: predictors and associated morbidities. Survival of extremely low-birth-weight infants. 40.93:138–44. Hulsey TC. Cousins L. Cattaneo A. Gordon A. 19.33:163– 9. Neonatal Research Network.136:61–9. Marlow N. Increasing ambient operating theatre temperature and wrapping in polyethylene improves admission temperature in premature infants. Am J Obstet Gynecol 1991. Acolet D. Evaluation of neonatal outcomes in elective repeat cesarean delivery at term according to weeks of gestation. J Trop Pediatr 1991.

DeSandre G. Manandhar DS. BMC Preg-nancy Childbirth 2012. Douglas E. Stanley FJ. 59. Yadav A. 61. Hypothermia at birth and its associated complications in new-born infants: a follow up study. Levy LI. Kreienbrock L.13:980–6. Neonatal hypoglycaemia in Nepal 1. 63. Nili F. Neonatal hypothermia on admission to a special care unit in Dar-es-Salaam. 54. Adekanmbi FA. Alberman EV. 58. Gould JB. Katz J. Giannone PJ. Gleissner M. S Med J 1984. Dev Med Child Neurol 1978. Tielsch JM. Speer CP. Analysis of morbidity and outcome of infants weighing less than 800 grams at birth. Evaluation of WHO classification of hypothermia in sick extramural neonates as predictor of fatality.90:F53–9. Carroll PD. risk factors and outcomes. Karp K. Iranian J Public Health 2006. Improving delivery room management for very preterm infants. 57. Utilization of postnatal care for newborns and its association with neonatal mortality in India: an analytical appraisal.35:48– 52. LeClerq SC. Harms K. Jegatheesan P. Sodemann M. Population based study on the outcome of small for gestational age newborns. Nayeri F. 56. Arch Dis Child Fetal Neonatal Ed 2000. Bartels DB. J Reprod Med 2010. Khatry SK. Jakobsen MS. 65.28:104–10. Z Geburtshilfe Perinatol 1985. Effective ventilation and temperature control are vital to outborn resuscitation. Lee HC. Kisenge R.82.49:23–7. Wyckoff MH. Manji KP. Elimination of admission hypothermia in preterm very low-birthweight infants by standardization of delivery room management.2:2. Obladen M. Pal DK. Nielsen J. Hanssler L. Robinson LE. Govindaswami B. Wenzlaff P. Heemann U. Singh A. de LCAM. Use of polyethylene bags in extremely low birth weight infant resuscitation for the prevention of hypother-mia. 69. Prehosp Emerg Care: Off J Natl Assoc EMS Phys Natl Assoc State EMS Dir 2004.20:300–12.8:191–5. Arch Dis Child Fetal Neonatal Ed 2005. Poets CF. Mishra TK. Ogunlesi TA. J Perinat Med 2000. Dammann O. 70. Nankervis CA. Song D. Shah S. 62.61:S26–30 [Suppl 1]. F46-F51. Darmstadt GL. Levi S. Miller SS. Factors associated with mortality and length of stay in hospitalised neonates in Eritrea. Factors influencing morbidity and mortality in infants with severe respiratory distress syndrome treated with single or multiple doses of a natural porcine surfactant. Manani M. Hypothermia in very low birth weight infants: distribution. 55. 68.17:8–13.31:S49–56 [Suppl 1]. Risk factors for intraventricular hemorrhage in a birth cohort of 3721 premature infants. Showalter L. Hypothermia of newborns is associated with excess mortality in the first 2 months of life in Guinea-Bissau. Infants of very low birthweight. Zemichael O. Africa: a cross-sectional study. Jorch G. Singh A.77:975–8. DeMauro SB. Permanente J 2013.164:650–6. Herting E. Hennecke KH. J Trop Pediatr 2005.51:341–5. Mullany LC. Biai S. Krishnamurthy S.189:181–7. Land JM. Avenarius S. 52. J Perinatol: Off J California Perinat Assoc 2011.51. Trop Med Int Health 2008. I: perinatal factors affecting survival. Fetuga BM. Cent Afr J Med 2003. pii: e000792. Taylor W. Risk of mor-tality associated with neonatal hypothermia in southern Nepal. et al. Cordero L. 60. West Africa. .132:e1018–25. Veirum J.55:9–13. Point-of-admission hypothermia among high-risk Nigerian newborns. et al. Pediatrics 2013. Mathur NB. Ogunfowora OB. 64.8:40. Olanrewaju DM. Patel N. Rajbhandari S. Biol Neonate 1992. 66. Perlman JM. Tanzania: a cause for concern.12:33. BMC Pediatr 2008. Arch Pediatr Adolesc Med 2010. BMJ Open 2012. 53. 67. Causes of neonatal mortality 1981–1983: a regional analysis. Meng HD. Aaby P. Prevalence and risk factors.

260 J. / Resuscitation 95 (2015) 249–263 . Wyllie et al.

105. Nimbalkar AS. 86. 98. 93. 106.9:238–44.132:e135–41. Morley CJ.93:779–85. Geneva. Dawson JA. Yoxall CW. A clinical compar-ison of radiant warmer and incubator care for preterm infants from birth to 1800 grams. Humidified and heated air during stabilization at birth improves temperature in preterm infants. de Klerk A. Accuracy of clin-ical assessment of infant heart rate in the delivery room. Lopez Escobar A. 94. 112.71. 95. Pediatrics 2000. Fawcus SR. Plastic bags for preven-tion of hypothermia in preterm and low birth weight infants. Widstrom AM. J Pediatr 2000. Everest NJ. Mathur G. World Health Organization: Department of Reproductive Health and Research (RHR). A randomised. metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. 75. Nelson KB.39:273–7. Fardig JA. 101. Wyllie JP. McCarthy LK. 76. Hutchinson C. Z Geburtshilfe Neonatol 1997. Vohra S. Schill M.49:110–3. Shakya KN. Babaei G.102:955–60. Walther FJ. Kamlin CO. Mazraani M. Ibrahim CP.201:258–62. Pediatrics 2001. J Nurse-Midwifery 1980. 81. A comparison of skin-to-skin contact and radiant heaters in promot-ing neonatal thermoregulation. Gokul E. Randomized trial of occlusive wrap for heat loss prevention in preterm infants.152:756–60. Randomized trial of plastic bags to prevent term neonatal hypothermia in a resource-poor setting. Hypother-mia in Iranian newborns. J Pediatr 1999. 74. O’Donnell CP. 82. J Pediatr 2008. Semin Perinatol 2010. Hellstrom-Westas L.30:45–9. Dietrich WD. Reilly MC. et al. J Perinatol: Off J California Perinat Assoc 2011. Finer N. et al. A logical regression analysis of 1100 cases. J Trop Pediatr 1993. Acta Paediatr 2010. Sabitha S. 80. Skin-to-skin contact may reduce negative consequences of “the stress of being born”: a study on temper-ature in newborn infants. Owen CJ. et al. Tilly AE. 107. Jensen S.137:739–40. 96. Morley CJ. Furdon SA. Use of a polyethylene bag: a way to improve the thermal environment of the premature newborn at the delivery room. van Elburg RM. Singh A. Temperature. Meyer MP. Pediatrics 2012. Marin Gabriel MA. Murphy JF.2:1225–8. Improving admission tempera -ture in extremely low birth weight infants: a hospital-based multiintervention quality improvement project. Implementation methods for deliv-ery room management: a quality improvement comparison study. 89. et al. Simionato L. Gopal SP. Lancet 1974. Use of self-heating gel mattresses eliminates admis-sion hypothermia in infants born below 28 weeks gestation. Petersburg. 92. Billimoria Z. 87.125:e1427–32.130:e1177–81. Kamlin CO. 91. 88. Natarajan G. 90. Hypoglycaemia: a com-mon problem among uncomplicated newborn infants in Nepal.132:e656–61.26:1367–71. Electrocardiogram provides a continuous heart rate faster than oximetry during neonatal resuscitation.25:19–28. Neonatal hypothermia in low-resource settings. Pediatrics 2013.2). Frent G. Neurosurgery 1996. Miller TR. 99. Pediatrics 2014.92:447–53. Dito I. O’Donnell CP. McCready M. Pedi-atrics 2014. Reducing hypothermia in preterm infants following delivery. Romero Blanco I. Boris-Moller F. Safety and efficacy of trans-warmer mattress for preterm neonates: results of a randomized controlled trial. Effect of early skin-to-skin contact following normal delivery on incidence of hypother-mia in neonates more than 1800 g: randomized control trial. Acta Paediatr 1992. Bjorklund LJ.81:488–93. Khanafshar N. polythene bags or a traditional approach? J Perinatol: Off J California Perinat Assoc 2010. Duckett J. et al. Reu-Donlon C. Wood FE. 100. Lieberman E. J Pediatr 2015. Linley LL. 111. Dugan R.34:364–8.31:780–4. et al. 109.38:533–41 [discussion 41]. Lee HC. Effect of polyethylene occlu-sive skin wrapping on heat loss in very low birth weight infants at delivery: a randomized trial. 83. 102. Zayeri F. Christensson K. Touza Pol P. Costello AM. Herting E. O’Donnell CP. Chawla S. Campbell V. et al. Watkinson M. Bennett MV. 103.41:455–60. Cohen A. See ref. et al. Pedi-atrics 2010. Ceylon Med J 2004. Busto R. Torres L. Davis PG. Lazic-Mitrovic T. Coimbra C. et al. Decreasing hypothermia during delivery room stabilization of preterm neonates. Bajaj M. Sasidharan CK. Siles C. Pinheiro JM. Morrison AC. Importance of pre-and perinatal risk factors in respiratory distress syndrome of premature infants. Matthiesen AS. Pediatrics 2013. Saudi Med J 2005. Fathers can effectively achieve heat conservation in healthy newborn infants. Pediatrics 2013. Leadford AE. Fernandez Villalba E. Whyte R. Reducing heat loss at birth in very preterm infants. Intrapartum fever and unexplained seizures in term infants. Jugie M. Alonso O. 78. Determination of heart rate in the baby at birth. Katheria A. Kron M. 73. Delayed posttraumatic brain hyper-thermia worsens outcome after fluid percussion brain injury: a light and electron microscopic study in rats. Mullany LC. 77. 72. Saraswat A. Ganjali M. Acta Paediatr 2003.108:395–401. Grether JK.169:795–9. Arch Pediatr 2002.166:e2262–8. Rac VE. Sethi A. Molloy EJ.34:426–33. Belsches TC. Diminished neuronal damage in the rat brain by late treatment with the antipyretic drug dipyrone or cooling following cerebral ischemia. et al. Llana Martin I. Djukic M. Lenclen R.32:260–7. Amaram A. Patel VK. Eichenwald E. Twomey AR. Payton MJ. . Richardson D. Moreno L. Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200. Phatak A. Resuscitation 2006.138:604–8. Accuracy of pulse oximetry mea-surement of heart rate of newborn infants in the delivery room.81:1000–3. J Perinat Med 2013.99:1630–4. Voogdt KG. Apgar V. Nayeri F.134:547–51. Pediatrics 2014. Manasyan A. Incidence. 108. Acta Paediatr 2004.133:e218–26. et al. Powers RJ. Dawson JA. 113.278:207–11. 1997. Kazemnejad A.85:1354–60. A proposal for a new method of evaluation of the newborn infant. subjected to different ward routines in St. Thermal protection of the newborn: a practical guide (WHO/RHT/MSM/97. Acta Paediatr 2013. 79. Maternal infection and cerebral palsy in infants of nor-mal birth weight. Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn. Wieloch T. Drake M. risk factors and related complications. 84. 110. Schiffmann H. Lopriore E. Halley M. Bystrova K. Cutura N. Patel DV. Newton T. Banks J. Harms K. Shrestha LN.92:320–6. Comparison of heart rate and oxygen saturation measurements from Masimo and Nellcor pulse oximeters in newly born term infants. Resuscitation 2010. Acta Paediatr 1996. te Pas AB. 104. Chamberlain G. India. Abbott M. Bergman NJ. 27. Wyllie JP. Salmon A. Curr Res Anesth Analg 1953.60:213–7.to 2199-gram newborns. Improving neonatal unit admission temperatures in preterm babies: exothermic mattresses.132:e128–34. Natarajan G.71:319–21.106:983–8. Anderson S. Acta Neuropathol 1996. Eur J Pediatr 2010.133:e1055–62. Resuscita-tion 2004. Incidence and risk factors for neonatal hypo-glycaemia in Kerala. Warren JB. 97.134:e1378–86. Russo A. Assessment of the Apgar score. 85. A randomized trial of exothermic mattresses for preterm newborns in polyethylene bags. Transitory hypothermia as early prognostic factor in term newborns with intrauterine growth retardation. J Perinatol: Off J California Perinat Assoc 2014. Boynton S. Rich W. Heffner L. Chawla S. Vohra S. Nimbalkar SM. Christensson K. simulated study assessing auscultation of heart rate at birth. Srp Arh Celok Lek 2010. JAMA 1997.

et al. 128. Gynecol Obstet Invest 2006. Harris Jr BA. Tuggle JM. et al. Morley CJ. Wyllie et al. Kamlin CO. Neonatal bradycardia following nasopharyngeal stimu-lation. Philips 3rd JB. Gannon CM. Bergert R. 124. 130. randomised controlled trial. Vivas NI. Chettri S. Ceyhan T. Hon EH. Am J Obstet Gynecol 1976. 129.151:731–6.54:205–7. Helmchen R. 117. J Pediatr 2015. Carson BS.78:441–7. / Resuscitation 95 (2015) 249–263 261 . Jacob J. Gurth H. Ting P. Rogers BP. Goktolga U. Oronasopharyngeal suction versus wip-ing of the mouth and nose at birth: a randomised equivalency trial. Carlin JB. Clinical assessment of infant colour at delivery.14:33. Szyld EG. Henderschott C. Gungor S. Falciglia HS. Mendis KB.49:32–8. Bhat BV. Paolata A. Positioning of term infants during delivery room routine handling—analysis of videos. Konstantelos D.382:326–30. Teksoz E. Al Takroni AM. Kurt E. Int J Gynaecol Obstet 1998. Vain NE.85:715–21. et al. Turner BS. Wiswell TE. J Pediatr 2015. Mami C. Prudent LM. Selective tracheal suctioning to prevent meconium aspiration syndrome. J. Wiswell TE. 127. J Pediatr 1971. Davis RO. Brewer JM. 119.63:259–63. Wilson ER. Reddy I. Combined obstetric and pediatric approach to prevent meconium aspiration syndrome. Lancet 2004. Pediatr Int 2012. Pulse oximetry measures a lower heart rate at birth compared with electrocardiography. 131. Cordero Jr L. Oropharyn -geal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre. Arch Dis Child Fetal Neonatal Ed 2007. Mizumoto H. Hassan S. Oronasopharyngeal suction versus no suction in normal and term infants delivered by elective cesarean section: a prospective randomized controlled trial. J Perinat Med 2001. Does DeLee suction at the perineum prevent meconium aspiration syndrome? Am J Obstet Gynecol 1992. Lancet 2013. Huddleston JF. Electrocardiogram shows reliable heart rates much earlier than pulse oximetry during neonatal resuscitation.29:465–8. Kelleher J.166:1208–13. 123.105:1–7. O’Donnell CP. Fatal meco-nium aspiration syndrome occurring despite airway management considered appropriate. 115. Ifflaender S. Rudiger M. Manganaro R.167:1243–9. Hooper SB. Waltman PA. Meconium aspiration syndrome: have we made a difference? Pediatrics 1990. Building evidence for practice: a pilot study of newborn bulb suctioning at birth. Kudair HA. Bhat R.114. BMC Pediatr 2014. Pediatrics 2000. Am J Obstet Gynecol 1985. et al. Shibata H. 121. Brady JP.126:712–5. Endotracheal suction for nonvigorous neonates born through meconium stained amniotic fluid: a randomized controlled trial. Palmara A. 116.166:49–53. Incidence of meconium aspiration syndrome in term meconium-stained babies managed at birth with selective tracheal intubation. 122. international collaborative trial. Adhisivam B. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter. May WL. Gemelli M. Salas AA. Baser I.122:767–71. 126. Losey RW. van Vonderen JJ. Davis PG. Tomotaki S. J Midwifery Womens Health 2004. Potter P. 118. Tracheal suction in meconium aspiration. Bowes Jr WA. Parvathi CK. Aguilar AM. Simmons MA. Am J Obstet Gynecol 1975. 120.61:9–14.92:F465–7. 125. Kroese JK.364:597–602. Wiswell TE.

Field D. Wood FE. What works best? Am J Dis Child 1992. Incomplete protection by prophy-lactic surfactant against the adverse effects of large lung inflations at birth in immature lambs.99:45–50. 145. Pre-ductal and post-ductal O2 saturation in healthy term neonates after birth. Salirrosas A. Resus-citation of preterm neonates by using room air or 100% oxygen. te Pas AB.73. 148.148:590–4. Copnell B.52:716–24. Willis D. J Pediatr 2006. Room-air versus oxygen adminis-tration for resuscitation of preterm infants: the ROAR study. Mask leak in one-person mask ventila-tion compared to two-person in newborn infant manikin study. Gamsu HR. controlled trial on initial respiratory support via nasopharyngeal tube. Feasibility of and delay in obtaining pulse oximetry during neonatal resuscitation. Rich W. 174. Schierbeek H. Ezquer A. Oxygen at birth and prolonged cerebral vasoconstriction in preterm infants. Vento M. 163. Fox GS. Tan A. Inflating pressures for effective resuscitation of preterm infants. Resuscitation of preterm infants with different inspired oxygen fractions. Dargaville PA. 165. Physiologic responses to prolonged and slow-rise inflation in the resuscitation of the asphyxiated newborn infant. Allen JR. Cavigioli F. J Pediatr 2011. Vento M.128:e374–81. 139.103:744–51. Dawson JA.125:e1340–7.2:189–93. Aguar M. Pediatrics 2013. Pediatr Res 2009. Obstet Gynecol 1994. 133. 151. Davis PG. et al.102:e90–3. J Pediatr 2005. et al. Hird MF. Morley CJ. Intensive Care Med 2004. Morley CJ. et al. 142. Coughtrey H. Assessing the effectiveness of two round neonatal resuscitation masks: study 1. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis. Hopkin IE. et al. Oxygen saturation and heart rate during delivery room resuscitation of infants <30 weeks’ gestation with air or 100% oxygen. Boon AW. Dani C.83:77–84. Chalak LF. Castoldi F. Copnell B. Dawson JA.171:679–84. Yoder BA. 159. et al. 173. 171. Ganzeboom A. Arch Dis Child Fetal Neonatal Ed 2008.95:1031–6. Mills JF. Morley CJ. Milner AD. 155. Kamlin CO. and chronic lung disease. Fluid recovery during lung lavage in meconium aspiration syndrome. Does sustained lung inflation at birth improve outcome of preterm infants at risk for respiratory distress syndrome? Neonatology 2011. van Roosmalen J. 136. Boon AW. Deleted in proof. 157. 160. Dawson JA. Singhal N. et al. Pediatrics 2011. Finer NN.4. 134. Wood FE. tidal exchange. Perlman JM. J Pediatr 1969. Arch Dis Child Fetal Neonatal Ed 2013. Hogel J. and forma-tion of the functional residual capacity during resuscitation of asphyxiated neonates. Davis PG. Hummler H.364:1329–33. 146. Intrathoracic pressure and volume changes during the spontaneous onset of respiration in babies born by cesarean section and by vaginal delivery. Arch Dis Child Fetal Neonatal Ed 2008. Arch Dis Child Fetal Neonatal Ed 2011. Vento M. Ingimarsson J. et al. Vince GS. Bates M. et al. et al. Pryds O. Davis PG. Kamlin CO. van den Berg PP. Arterial oxygen saturation in healthy newborns delivered at term in Cerro de Pasco (4340 m) and Lima (150 m). Mills JF.146:1085–9.121:1083–9. J Pediatr 1981. 156. et al. Badiee Z. Chang A. Davis PG. Milner AD. inflammation. Smith JB. 172. 158. Savani RC. Arch Dis Child Fetal Neonatal Ed 2010. Rabi Y. Pediatrics 2015.135:e457–64. 144. O’Donnell CP. Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room. Lung expansion and ventilation during resuscitation of asphyxiated newborn infants. Schmolzer GM. J Pediatr 2007. 152. O’Donnell CP. Tracy MB. Hopkin IE.96:F195–200. Vyas H.98:F222–7. Defining the reference range for oxygen saturation for infants after birth. Pohlandt F. O’Donnell CP.95: F393–7. Lista G. Pediatrics 2009.93:F230–4. Resuscitation of preterm newborns with low con-centration oxygen versus high concentration oxygen. J Res Pharm Pract 2012. Arch Dis Child Fetal Neonatal Ed 2009. Schmolzer GM. Resuscitation 2010. J Pediatr 1981. Am J Obstet Gynecol 1994.132. Milner AD. Chen SY. Boni L. resuscitation of near-term asphyxiated lambs. Rabi Y. Sparks JE. Sustained lung inflation at birth for preterm infants: a randomized clinical trial.164:e31322–6. Hooper SB. 135. . Klingenberg C. Gonzales GF.26:69–72. Weeks S. Moro M. Klimek J. et al.3:46. Morley CJ.99:635–9. 138. Lancet 2004. Hopkins IE. Greenough A. Early Hum Dev 1991. 141. Vento M. 149.30:1446–53. Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at <=32 weeks. Lundstrom KE.94:303–9. Dildy GA. Yoxall CW.99:787–91.75:47–58. Does sustained lung inflation at resuscitation reduce lung injury in the preterm infant? Arch Dis Child Fetal Neonatal Ed 2005. Escrig R. te Pas AB. et al. Lindner W. Lung expansion. Bjorklund LJ. Harling AE. Removing meconium from infant tracheae. Vossbeck S. et al. Kattwinkel J. Hull D. Improved techniques reduce face mask leak during simulated neonatal resuscitation: study 2. Part 11: neonatal resuscitation: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. J Pediatr 1979. Kamlin OC. Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome. Pediatrics 2008. Smit M. Dawson JA. Sustained pressure-controlled inflation or inter-mittent mandatory ventilation in preterm infants in the delivery room? A randomized. Acta Paediatr 2014. et al. Rook D. 166.103:961–7. Katz M. Fisher JT. Vyas H. et al. Arch Dis Child Fetal Neonatal Ed 1995. Milner AD. 170. 162. F81-F6. Nettel-Aguirre A. 154. 169. Acta Paediatr 2013. Yee W. 161. Meconium-stained amniotic fluid and respiratory complications: impact of selective tracheal suction. Singhal N. Dawson JA. Lista G. Bent RC. Oxygen saturation trends immediately after birth. Fontana P. Aune D. Arch Dis Child Fetal Neonatal Ed 2014. Scopesi F. Dawson JA. Greisen G. Wyckoff MH. J Appl Physiol 1982. Saugstad OD. 147. Preterm resuscitation with low oxygen causes less oxidative stress. Leone TA. Wong C. 167. Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation? Pediatrics 1999. 164. Wallace MJ. Beresford MW. Dawson JA. 150. Pediatrics 2010.99:F309–14. Lindner W. Effect of sustained inflation length on estab-lishing functional residual capacity at birth in ventilated premature rabbits. Kapadia V. Anderson C. 143.150:418–21.132:e1488–96. Mariani G. Pediatr Pulmonol 1986. Mortola JP. Dik PB. et al. Kamlin CO.158:e2383–9. Reprod Biol Endocrinol 2005. Kapadia VS. Morley CJ.66:295–300. Arch Dis Child Fetal Neonatal Ed 2011.90:F406–10. Determinants of the first inspi-ratory volume and functional residual capacity at birth. O’Donnell CP.147: 698–9. Armanian AM. J Pediatr 2014. 153.96:F254–7. Schulze A. Kamlin CO. Siew M.81:Se260–87 [Suppl 1].93:F235–7. Pohlandt F. Sobotka KS. Dargaville PA. Vyas H.1:25–9. Ong T. Wiswell TE. 140. Govindaswami B. Effect of sustained inflation duration. Air-way obstruction and gas leak during mask ventilation of preterm infants in the delivery room. Hopkin IE. Finer N. Wang CL. Pulse oximetry in newborns with delayed cord clamping and immediate skin-to-skin contact. Intrapartum fetal pulse oximetry: fetal oxygen saturation trends during labor and relation to delivery outcome. Acta Paediatr 2005. 168. Resuscita -tion of preterm neonates with limited versus high oxygen strategy. 137.94:F87–91. Wyllie J. Curstedt T. Onset of respiration in infants delivered by cesarean section.

Morley CJ. Dawson JA. Hew EM. Polglase GR. 189. et al. Hillman NH. Schmolzer G. Finer NN. Musante GA. Mullen JB.175. Resuscitation 2001.164:494–8.47:698–703. 183. Aguilar A. Naik AS. Oddie S. 181. Hoskyns EW. Providing PEEP dur-ing neonatal resuscitation: which device is best? J Paediatr Child Health 2011. 182. Kelm M. Roehr CC. Am J Respir Crit Care Med 1994. The effect of a PEEP valve on a Laerdal neonatal self-inflating resuscitation bag. 195. Positive end expiratory pressure during resuscitation of premature lambs rapidly improves blood gases without adversely affecting arterial pressure. Pillow JJ. et al. 194. Anesthesiology 1979. et al. Proquitte H. Acta Pathol Microbiol Scand 1980. Proquitte H. Baumer JH. Bennett S. Scally A. Kallapur SG. Dawson JA. Tidal ventilation at low airway pressures can augment lung injury. 180. Muscedere JG. Allwood AC. A comparison of three neonatal resus-citation devices. Vaucher Y. Henderson C. te Pas AB.81:202–5. Nilsson R. Madar RJ.158:912–8 [e1–2]. Evaluation of mask-bag ventilation in resuscitation of infants. 193. Man-ual ventilation devices in neonatal resuscitation: tidal volume and positive pressure-provision. Stewart MJ. Is Ambu ventilation of new-born infants a simple question of finger-touch? Arch Pediatr 1996. Rich W. Fischer HS. Schmalisch G. Schmalisch G. Kelm M. Repeated thermo-sterilisation further affects the reliability of positive end-expiratory pressure valves. Resuscitation 2005. Am J Dis Child 1987. 178. . Am J Respir Crit Care Med 2001. Ganga-Zandzou PS. Hussain F. Wallace MJ. 190. Pediatr Res 2008. Changes in resuscitation practice at birth. Slutsky AS. J Pediatr 2011. et al. 176. Bachurski CJ. A simple method of face mask resuscitation at birth. 184. Rolbin SH.46:51–6. Use of self-inflating bags for neonatal resuscitation. Storme L.88:359–67.51:356–8. Szyld E.221:415–8. Arch Dis Child 1987.56:198–204. Schmolzer GM.149: 1327–34. Comparison of methods of bag and mask ventilation for neonatal resuscitation. J Pediatr 2014. Effects of ventilation with different positive end-expiratory pressures on cytokine expression in the preterm lamb lung. Readdy L. Resuscitation 2005.67:113–8. J Paediatr Child Health 2010.165:e3234–9. Gan K. Hooper SB. et al. Milner AD. 188. 191. Schmalisch G.88:F375–9. Siew M. An improved ventilator system for delivery-room management of the newborn. Davis PG. 186. Kamlin CO. Establishing functional residual capacity at birth: the effect of sustained inflation and positive endexpiratory pressure in a preterm rabbit model. Positive end-expiratory pressure and tidal volume during initial ventilation of preterm lambs. et al. Davis PG. Rich W. Dargaville PA.49:299–305.62:376–8. Probyn ME.65:537–41. 185. Buhrer C. Pediatr Res 2009. Klin Padiatr 2009. Grossmann G. Wright D. Roehr CC.67:109–12. Hopkin IE. Gerber A. Pynn S.3:1270–2. Arch Dis Child Fetal Neonatal Ed 2003. Resuscitation 2010. Diependaele JF.141:761–3. Cole AF. Robertson B. Oxygenation with T-piece versus self-inflating bag for ventilation of extremely preterm infants at birth: a ran-domized controlled trial. Pediatr Res 2004.49:741–5. 187. 179. Craft A. Wyllie J. Kamlin CO.64:517–22. Finer NN. 192. 177. Dawson JA. Kanter RK. Comparison of devices for newborn ventilation in the delivery room. Bronchiolar epithelial lesions induced in the premature rabbit neonate by short periods of artificial ventilation. et al. Reliability of two com-mon PEEP-generating devices used in neonatal resuscitation. Roehr CC. Morley CJ. Hartung JC. J Paediatr Child Health 2013.

262 J. / Resuscitation 95 (2015) 249–263 . Wyllie et al.

de Klerk A.62:151–7.1:1024–5. A note of caution about the continuous use of colori-metric end-tidal CO2 detectors in children. N Engl J Med 1963.81:552–4. et al. Supraglottic airway devices during neonatal resuscitation: an historical perspective. Pediatrics 1995. Martin JB.128:e1069–76. Palme-Kilander C.19:110–3. Jones MD. Cho Y. Use of capnography in the delivery room for assessment of endotracheal tube placement. Kempley ST. Cohen AR. Moreiras JW. 207. 233. J Perinatol: Off J California Perinat Assoc 1999. Frank LR. Rich W.132:e389–95. et al. Pitton M.118. Two-thumb vs two-finger chest compression in an infant model of prolonged cardiopulmonary resuscitation. Rogers MC. Slywka B. Cardiac massage in the newborn infant through the intact chest. Hascoet JM. 224. Maguire S. Trevisanuto D. et al.95:800–1. Arch Dis Child 1993. Wadas RJ.21:284–7. Cavallin F. The use of capnography for recognition of esophageal intubation in the neonatal intensive care unit. Dorfsman ML. Singh R. Nogee LM. Tunell R. Brion LP.81:712–7.96:F99–101. Finer NN. Davis PG. Wyckoff MH. James LS. Respiratory function monitor guid-ance of mask ventilation in the delivery room: a feasibility study. 202.18:1659–67. 199. Rack L. Moore JJ. Udassi S. Murphy JF. Maniscalco WM. Laryngeal mask airway versus endotracheal intubation for Apgar score improvement in neonatal resuscitation. Baker SF. Menegazzi JJ. Menegazzi JJ. Pulmonary gas exchange during facemask ventila-tion immediately after birth. Hishikawa K.21:303–6. Ann Emerg Med 1993. Prehosp Emerg Care: Off J Natl Assoc EMS Phys Natl Assoc State EMS Dir 1997. 234. Leone TA. Resuscitation 2013. Pediatrics 2006. Theobald PS. 214. Kamlin CO. Mask versus nasal tube for stabi-lization of preterm infants at birth: a randomized controlled trial. Zanardo V. 217. Finer NN. Lamb MA. O’Donnell CP. Saleh M. 223. Repetto JE. A randomized. Rudiger M. N Engl J Med 2010. Agarwal M. Chhibber A. Whitelaw CC. 220. Pediatrics 1988. Disposable colorimetric carbon diox-ide detector use as an indicator of a patent airway during noninvasive mask ventilation. Maguire SA.18:115–21. Auble TE. Leone TA. Petrone FL. pii: fetalneonatal-2014-307891. Rich W. 231. Garey DM. pii: fetalneonatal-2015-308236. Morley CJ. Schmolzer GM. Comparison of a two-finger versus two-thumb method for chest compressions by healthcare providers in an infant mechanical model. Emerg Med J: EMJ 2013. J Perinatol: Off J California Perinat Assoc 2001. Kelly L. Moya F. Ito Y. Carlin JB. 197. Supreme laryngeal mask airway versus face mask during neonatal resuscitation: a randomized controlled trial. Stobie GH. 228. J Perinat Med 2009.30:139–42. Laryn-geal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation 2004. et al. 208. Pulmonary air leak associated with CPAP at term birth resuscitation. 209. Davis PG. Roberts WA.196. Jones M. Pediatr Pulmonol 1995. Esmail N. 213. et al. Resuscitation 2008. 218. Donohue P-CP. Martin P. Two-thumb technique is superior to two-finger technique during lone rescuer infant manikin CPR. Hosono S. 226. Todres ID. Schilleman K. 221. Dellimore K. Orlowski JP. Taylor R.132:e381–8. Arch Dis Child Fetal Neonatal Ed 2014. 235. Mugishima H. Ryu S. Controlled trial to evaluate the use of LMA for neonatal resuscitation. J Anaesthiol Clin Pharmacol 2005. Goode JS. Trevisanuto D. Yoon C. Nasal CPAP or intubation at birth for very preterm infants. LaCovey D. Hanks EC. J Pediatr 2015. Yu RJ. Houri PK. Bhende MS. Ward R. Thaler MM. Hosack GM.358:700–8. Kong JY. Magarotto M. et al. Park J. Goldsmith LJ. Schmolzer GM. 216. Pediatrics 2013.37:79–84. Burnard ED. Fujiwara T. Theobald P. 200. Egypt J Anesthesiol 2002. 212. The two-thumb is supe-rior to the two-finger method for administering chest compressions in a manikin model of neonatal resuscitation. Acad Emerg Med: Off J Soc Acad Emerg Med 2000. Molloy EJ.1:65–7. Piva D.82:1405–9. Kemp A.362:1970– 9.167:286–91. Carlo WA.160:e2377–81. Christman C. et al. Lim JS.121:e1524–7. 203. Manikin-integrated digital measuring system for assessment of infant cardiopulmonary resuscitation techniques. 204.7: 1077–82. Zhu XY.84:798–803. Resuscitation 2000. Conf Proc IEEE Eng Med Biol Soc 2013. Wong C. Am J Obstet Gynecol 1962. Network SSGotEKSNNR. Leone T. Minato M. Zhang QS. J Pediatr 2013. Quantitative end-tidal carbon diox-ide monitoring in the delivery room: a randomized controlled trial. Perlman JM. 205. Morley CJ. Finer NN. Endotracheal tube length for neonatal intubation. Takahashi S. 230. Gohier F.43:213–6. 210.98:576–81. 206. An improved technique of external caridac compression in infants and young children. David R. Do chest compressions during simulated infant CPR comply with international recom-mendations? Arch Dis Child 2013. Hemway RJ. Pediatrics 2008. Dunn MS. Resuscitation 2010. Twomey AR. 232.99:F344.68:11–6. 222. Vocal cord guides on neonatal endotracheal tubes. Dawson JA. Development of a diagnostic glove for unobtrusive measurement of chest compression force and depth during neonatal CPR. The pediatric disposable end-tidal carbon diox-ide detector role in endotracheal intubation in newborns. Phillips GW. Kamlin CO. O’Donnell CP.77:369–73. 211. Aziz HF. Kaempf J. Martin PS. 236. A randomized trial of nasal prong or face mask for respiratory support for preterm newborns. J Pediatr 2012. A role of end-tidal CO(2) monitoring for assessment of tracheal intubations in very low birth weight infants during neonatal resuscitation at birth. Micaglio M. Ye HM. N Engl J Med 2008. Gill I. Heunis S. Methods of external cardiac massage in the newborn infant.163:e1104–8. J Pediatr 1975. Sago H. Ann Emerg Med 1986. Comparison of overlapping (OP) and adjacent thumb positions (AP) for cardiac compressions using the encircling method in infants.22:240–3. Heldt G. Menegazzi JJ. et al. Finer NN.19:262–8. et al. Pedi-atrics 2011.2013: 350–3. 237. A prospective evaluation of the effi-cacy of the laryngeal mask airway during neonatal resuscitation. Lin BC. Mask CPAP during neonatal transition: too much of a good thing for some term infants? Arch Dis Child Fetal Neonatal Ed 2015. Two-thumb versus two-finger chest compression during CRP in a swine infant model of cardiac arrest. systematic review and meta-analysis of available clinical trials. Lancet 1986. 198. Udassi JP. Early CPAP versus surfactant in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2011. Pediatrics 2013. Lange A. 227. Lee JC. 219. Real-time feedback can improve infant manikin cardiopulmonary resuscitation by up to 79%—a randomised controlled trial. 201.84:722–30. Nicklas KA. Fujita H. Optimum position for external cardiac compression in infants and young children.15:667–73. McCarthy LK. Maconochie I. Closed chest cardiac massage in the newborn infant. 215. Litman RS. Relation of infant heart to sternum: its significance in cardiopulmonary resuscitation. Inami I. 229. Poets CF. Kemp AM. Arch Dis Child Fetal Neonatal Ed 2015. Zideman DA. controlled trial of two-thumb vs two-finger chest compression in a swine infant model of cardiac arrest [see comment]. Auble TE. Resuscitation 2011. Kaneshige M. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates.86:781–2. Nguyen LN. Rich W. Resuscitation 2013.84:1125–30. IEEE J Biomed Health Inf 2014. e202-e204. 225. Doyle LW. .269:606–10. Tidal volume thresh-old for colorimetric carbon dioxide detectors available for use in neonates. Goishi K.

65:57–61. Wyckoff M. Gupta N. different ventilation rates. High brain tissue oxygen tension during ventilation with 100% oxygen after fetal asphyxia in newborn sheep.96:F417–21. Solevag AL. Normoxic ventilation during resus-citation and outcome from asphyxial cardiac arrest in rats. Neonatology 2010. Solevag AL. et al. Christman C. Blood flow during cardiopul-monary resuscitation with simultaneous compression and ventilation in infant pigs.39:335–43. Optimum location for chest compressions during two-rescuer infant cardiopulmonary resuscitation. Lipinski CA. Nordh A. and continuous chest compressions with asynchronous ventilation in a newborn manikin. Extended series of cardiac compressions during CPR in a swine model of perinatal asphyxia. 241. Solevag AL. Wyckoff M. Berkowitz ID. Linner R. Pediatr Res 1989.26:558–64. J. Werner O. J Perinatol: Off J California Perinat Assoc 2012. 249. Chantarojanasiri T. et al. Glumac A. Circulatory recovery is as fast with air ventilation as with 100% oxygen after asphyxiainduced cardiac arrest in piglets. Saugstad OD. Cunha-Goncalves D. Solevag AL.66:391–4. Return of spon-taneous circulation with a compression:ventilation ratio of 15:2 versus 3:1 in newborn pigs with cardiac arrest due to asphyxia. Lung injury in asphyxiated newborn pigs resuscitated from cardiac arrest—the impact of supplemen-tary oxygen. Temesvari P. Tang M. Saugstad OD.98:64–72. 239. Karg E. 251. A comparison of two-fingers technique and two-thumbs encircling hands technique of chest compression in neonates. Improved blood flow during prolonged cardiopulmonary resuscitation with 30% duty cycle in infant pigs. Gjaerum E. Crit Care Med 2011. Circulation 1991. Nakstad B. Solevag AL. 244. Nakstad B. Kumar P.49:812–9. et al. et al. Koehler RC. Callaway CW. Resuscitation of severely asphyctic newborn pigs with cardiac arrest by using 21% or 100% oxygen. Pediatr Res 2013.81:1571–6.81:544–8. Schleien CL. The 3:1 is superior to a 15:2 ratio in a newborn manikin model in terms of quality of chest compressions and number of ventilations. 242. Pediatr Res 2009. longer ventilation intervals and chest compressions at different compression-to-ventilation ratios. Brain inflammation induced by severe asphyxia in newborn pigs and the impact of alternative resuscitation strategies on the newborn central nervous system. 250. Perlman J. Perez-de-Sa V. Nakstad B. Arch Dis Child Fetal Neonatal Ed 2013. Solevag AL. Kaur H.238. Saini SS. Pollock A. Resuscitation 1999. Pediatr Res 2001. Pediatr Res 2009. Madland JM. Bhalla AK. Saugstad OD. Scand J Trauma Resuscitation Emerg Med 2012. Evaluation of the Neonatal Resuscita -tion Program’s recommended chest compression depth using computerized tomography imaging. Hemway RJ. Resuscitation 2010. Open Respir Med J 2012. Cunha-Goncalves D. et al. Dannevig I. Wyllie et al.98:F42–5. Saugstad OD. et al. 245. Sonerud T. 247. Nakstad B. / Resuscitation 95 (2015) 249–263 263 .80:1378–81. 240. Arch Dis Child Fetal Neonatal Ed 2011. Dannevig I. Resuscitation 2009.32:690–4.6:89–96. Perez-de-Sa V. Resuscitation 2010. Dannevig I. 243. Dean JM. Meyer A. Walson KH.42:221–9. 246. Nakstad B. Dannevig I. Minute ventilation at different compression to ventilation ratios.73:163–70. Dannevig I. Normoxic versus hyperoxic resuscitation in pediatric asphyxial cardiac arrest: effects on oxidative stress. Koehler RC. 253. You Y. Saugstad OD. Impaired early neurologic outcome in new-born piglets reoxygenated with 100% oxygen compared with room air after pneumothorax-induced asphyxia. Nadkarni V. 252.84:896–904. 248. 254. Bodi I.20:73. Nakstad B. Hicks SD.

Posthypoxic glucose supplement reduces hypoxic-ischemic brain damage in the neonatal rat. Irons TG. Azzopardi D. J Perinatol: Off J California Perinat Assoc 1995. Mielke LL. Frank C. Crit Care Med 1987. Devidas M. Crit Care Med 1994. 259. Am J Obstet Gynecol 2007. Li L. Marlow N. Ambalavanan N. N Engl J Med 1988. Spinella PC. Prediction of death for extremely low birth weight neonates. 258. 286. Kendrick ZV. Pediatrics 2004. European Resuscitation Council guidelines for resuscitation 2005 Section 8. Plasma catecholamine levels following tracheal and intravenous epinephrine administration in swine. Initial end-tidal CO2 is markedly elevated during cardiopulmonary resuscitation after asphyxial cardiac arrest. Eur J Cardiovasc Nurs 2007. The presence of family members during cardiopulmonary resuscitation: European federation of Critical Care Nursing associations. Nadkarni V. Obstetric determinants of neonatal sur-vival: antenatal predictors of neonatal survival and morbidity in extremely low birth weight infants. et al.100:F102–5. 271. Norman ME. Towfighi J. Ravelli AC. Evaluation of an end-tidal CO2 detector during cardiopulmonary resuscitation in a canine model for pediatric cardiac arrest. Resuscitation 2005. Stroke 2001. Endobronchial instillation of epinephrine during cardiopulmonary resuscitation. Pediatr Res 2011. 256. Knaub MA. 295.180:665–9. Stoeckel H. Jasani MS.115:950–5. Field DJ. 293. Karasic RB. Schmeidler J. Oberdorf MA. 257.25:1443–7 [discussion 8]. Poor outcome after hypoxia-ischemia in newborns is associated with physiological abnor-malities during early recovery. Heitjan DF. Christie L. Ann Neurol 1978.95:F293–4. Finkelstein MS. Kasdorf E. Draper ES. Glucose given after hypoxic ischemia does not affect brain injury in piglets. Laptook AR. Salzman SK. Wyckoff MH.114:361–6. The long-term out-come in surviving infants with Apgar zero at 10 minutes: a systematic review of the literature and hospital-based cohort. J Paediatr Child Health 2004.36:187–92.6:255–8. Oxygen requirement during car-diopulmonary resuscitation (CPR) to effect return of spontaneous circulation. Pediatrics 2013. Patel H. Wasterlain CG. Roberts JR. Moulden M. 278. Kopelman AE. Laptook AR. Arch Dis Child Fetal Neonatal Ed 2014. Aune SE. Costeloe KL. Between-hospital variation in treatment and outcomes in extremely preterm infants. Resuscitation 2009. Comparison of two doses of endotracheal epinephrine in a cardiac arrest model. Laptook AR. Shankaran S. 268. Mercer BM. Speidel BD.99:F181–8. Smith EE. Barks JD. Marlow N. Henry C.15:1037–9. Perceptions of the limit of viability: neonatologists’ attitudes toward extremely preterm infants. Wyckoff MH. 273. Lanzinger MJ. Effects of different techniques of endotracheal epinephrine administration in pediatric porcine hypoxic-hypercarbic cardiopulmonary arrest. PloS One 2011.28:122–8. The ethics of resuscitation and end-of-life decisions. Drott HR. Redman CW. JACEP 1979. Bell EF.95:F423–8. F112-F5. Perlman JM.32:2318– 27. Perlman JM. et al. N Engl J Med 2008.88:110–4. N Engl J Med 2015.131:e425–32. 269.4:73–9. Effect of insulin-induced and fasting hypoglycemia on perinatal hypoxic-ischemic brain damage. Cox M. Huang M. Possible relevance to secondary brain injury after head trauma in infants. Medlock S. Pediatr Emerg Care 1995. Arch Dis Child Fetal Neonatal Ed 1998. Rysavy MA. Pediatr Crit Care Med: J Soc Crit Care Med World Federation Pediatric Intensive Crit Care Soc 2004. Koehler RC. Population-based estimates of in-unit survival for very preterm infants. Comparison of the attitudes of health care profes-sionals and parents toward active treatment of very low birth weight infants. Cerebral carbohydrate metabolism during hypo-glycemia and anoxia in newborn rats. et al.255. Langer J. 277.51:151–62.14:349–50. Bennett C. et al. Arch Dis Child Fetal Neonatal Ed 2010. Roth CL. Patel D. Vannucci SJ. Hornchen U. Mohapatra S. Hennessy EM. Peri-natal outcomes for extremely preterm babies in relation to place of birth in England: the EPICure 2 study. Manktelow BN. Perlman JM. Initial hypoglycemia and neonatal brain injury in term infants with severe fetal acidemia. Pediatrics 1995. Garcia D. 272. Rosenkrantz TS. Associ-ation of timing. End-tidal carbon dioxide changes during cardiopulmonary resuscitation after experimental asphyxial cardiac arrest. 266. Penner PL. 283.6:e23441. Dechert RE. Bhende MS.372:1801–11. 292. and intensity of hyperglycemia with intensive care unit mortality in critically ill children. Donohue PK. Intensive care for extreme prematurity—moving beyond gestational age. Beeby PJ. 285. Fulbrook P. Critical care decisions in fetal and neonatal medicine: ethical issues. 2006 ISBN 1 904384 14.358:1672–81. Berg RA. et al. 294. Resuscitation 1998. 288. Carlo WA. Menegazzi JJ. Crespo SG. Improving infant outcome with a 10 min Apgar of 0. duration. Pedi-atrics 2009. J Pediatr 2008. Vannucci RC. Pediatrics 2005. Evaluation of an end-tidal CO2 detector during pediatric cardiopulmonary resuscitation. Hattori H. 287. 290.22:1174–80. 267. Ichord RN. Salhab WA. Mol BW. 279. Nuffield Council on Bioethics. End-tidal CO(2) detection of an audible heart rate during neonatal cardiopulmonary resuscitation after asystole in asphyxiated piglets. Steen PA. Stroke 1994. Sarkar S. Hynan L. Hojsak JM. Nadkarni VM. Ambalavanan N.80:951–5. Yeh ST. Embleton ND. 260.31:138–42. Blood levels following intravenous and endotracheal epinephrine administration. 291. et al. Barber CA. 289. Ann Neurol 1990. 262. 274. Abu-Hanna A. Sanders MR.78.153:379–84. Martin LJ. Klein GW. 265.318:677–83. . Bhende MS.11:365–8.20:230–4. Casalaz DM. Pediatrics 2005. Allen MC. Tyson JE.15:494–502. Swamy R. Prediction of mor-tality in very premature infants: a systematic review of prediction models. Ann Emerg Med 1991. Draper ES.69:401–5.67:S171–80 [Suppl 1].124:1619–26. Traystman RJ. 284. Vannucci RC. Exp Toxicol Pathol 1999. Harrington DJ. Brambrink AM. Fabian RH. 280. Thompson AE. Pediatr Emerg Care 1996.40:136–8. Heterogeneity affecting outcome from acute stroke therapy: making reperfusion worse. Bobashev G.95:395–9. Soukup VM. Use of volume expansion during delivery room resuscitation in near-term and term infants. Parikh NA. 264. Karasic DG. 282. Seaton SE. Greenberg MI. Greenwood CE. Latour J. Cawley RJ. Outcome of term infants using apgar scores at 10 minutes following hypoxic-ischemic encephalopathy. Pediatr Res 1992. Rapaport R. Hahn N. Morgan AS. Survival in infants live born at less than 24 weeks’ gestation: the hidden morbidity of nonsurvivors. Bhagat I. Srinivasan V.12:245–8. 276. Kent TA. Predicting death despite therapeu-tic hypothermia in infants with hypoxic-ischaemic encephalopathy. Pediatrics 1991. Angelos MG. Resuscitation beyond 10 minutes of term babies born without signs of life. Baskin SI. Spivey WH. Bossaert L. Karasic DG.196:e1–5. Am J Obstet Gynecol 1999. Bythell M. LeBlanc MH. 275. Schoffstall JM. Yager JY. 263. Neonatologists judge the “Baby Doe” regulations. European Society of Paediatric and Neonatal Intensive Care and European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement. Helfaer MA. Kopelman LM. Jacobs S. Bhende MS. Am J Emerg Med 1996.5:329–36.116:1367–73. Hyperglycemia and outcome in the pediatric intensive care unit. 270. Eichelkraut W. Laptook A.8:53–6. Arch Dis Child Fetal Neonatal Ed 2010. 281. Paul RH. Arch Dis Child Fetal Neonatal Ed 2015. Bottoms SF. Wyckoff MH. Baskett PJ. 261. Fuhs LR. Lee SK. Albarran J. et al. et al. Tamminga P. Chalak LF. Otto CW. Mandell GA. Schuttler J. Outcome of resuscitation following unex-pected apparent stillbirth.

A method for measuring the effectiveness of simulation-based team training for improving communi-cation skills. Naik VN. Crit Care Med 2007. Dufresne RL. Preterm resuscitation I: clin-ical approaches to improve management in delivery room. Ehrenkranz RA. Sheikh M. Mayer B. Pell JP. Prospec-tive risk factor monitoring reduces intracranial hemorrhage rates in preterm infants.105:279–85. Cooper JB. 302. Park J. 309. Schaefer J. DeVita MA. Sebastian M. 301. et al. N Engl J Med 2009.353:1574–84. et al.371:140–9. Dongilli T. Schmid MB. Shankaran S. Eicher DJ.15:18. Marlow N. Wagner CL. 299. Smith GC. . 298. Early Hum Dev 2011. Gluckman PD. Azzopardi D.14:326–31. et al. Raemer DB. 300.110:489–96. Moderate hypothermia to treat perinatal asphyxial encephalopathy. Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial. et al. Hamstra SJ. Value of debriefing during simulated crisis management: oral versus videoassisted oral feedback. Laptook AR. et al. Que L. 304. Clay AS. Gunn AJ. Anesthesiology 2006. 311. Arora V. Bergert R. et al. Braun N. Dinger J.87:749–53. et al. Lutz J. 305. Petrusa ER. Hopfner RJ. Whole-body hypother-mia for neonates with hypoxic-ischemic encephalopathy. Effects of hypothermia for perinatal asphyxia on childhood outcomes. Wyatt JS. Azzopardi DV.168:1063–9. 308.384:1749–55. Govert J.35:738–54. Aranda J.365:663–70. Brocklehurst P.296. Chow R. PloS One 2015. BMJ 2010. Gurth H. 297. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data. Neonatal assessment in the delivery room—Trial to Evaluate a Specified Type of Apgar (TEST-Apgar). Arch Intern Med 2008. Apgar score and the risk of cause-specific infant mortality: a population-based cohort study.340:c363. et al. Iliodromiti S. Reister F. Rudiger M. Braun N. Mackay DF.100:1375–80 [table of contents]. 303. Nayeri F. Butter J. Anesth Analg 2005. Joo HS. Qual Saf Health Care 2005. BMC Pediatr 2015. et al. Nelson SM. Fuchs H. Litzinger B. Pediatr Neurol 2005. Savoldelli GL. Teach Learn Med 2005. 310. Strohm B. Dtsch Arzteblatt Int 2013. Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes. Azzopardi D. Katikaneni LP. Siddall VJ. Selective head cooling with mild sys-temic hypothermia after neonatal encephalopathy: multicentre randomised trial. Rudiger M. Hummler HD. Strohm B. Hardani AK. Debriefing in the inten-sive care unit: a feedback tool to facilitate bedside teaching. 306. Nili F. Wang H.32:11– 7. Edwards AD. Wayne DB. 307.10:e0122116.17:210–6. Carroll JS. Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Dalili H. Improving in-hospital cardiac arrest process and outcomes with performance debriefing. N Engl J Med 2014. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Lancet 2014.361:1349– 58. Blum RH. 312. Shariat M. Lancet 2005. Edelson DP. Edwards AD. N Engl J Med 2005.