Thomas Nicolai1. 1. University Children's Hospital, Dr v Haunersches Kinderspital, Munich, Germany. tnicolai@med.uni-muenchen.de
Abstract
PURPOSE OF REVIEW: The new International Liaison Committee on Resuscitation documents, published in 2005, include important changes in pediatric resuscitation. Some issues that were left pending have since been supplemented with new studies. Their impact will be discussed here. RECENT FINDINGS: Studies on oxygen use for neonatal resuscitation have consistently found room air to be superior to 100% oxygen. Prospective studies indicate that intubation by first responders in preclinical resuscitation of children is dangerous and should probably be avoided. New studies point to a better neurological outcome with hypothermia in neurologically depressed neonates after perinatal asphyxia. SUMMARY: Resuscitation of 'depressed' near-term neonates should be started with an oxygen content of less than 100%, and only change to 100% if the child remains bradycardic and cyanotic. A neonate who can be resuscitated with room air will receive no benefit from 100% oxygen and may even have a worse outcome. If the first responder in a pediatric emergency is out of training with pediatric intubation he or she should feel reassured that resuscitation without an attempt at endotracheal intubation is acceptable. Presently, hypothermia in neonates after birth asphyxia should be used within controlled studies, or at least follow the protocols of published studies and be performed in specialized centers.
PURPOSE OF REVIEW: The new International Liaison Committee on Resuscitation documents, published in 2005, include important changes in pediatric resuscitation. Some issues that were left pending have since been supplemented with new studies. Their impact will be discussed here. RECENT FINDINGS: Studies on oxygen use for neonatal resuscitation have consistently found room air to be superior to 100% oxygen. Prospective studies indicate that intubation by first responders in preclinical resuscitation of children is dangerous and should probably be avoided. New studies point to a better neurological outcome with hypothermia in neurologically depressed neonates after perinatal asphyxia. SUMMARY: Resuscitation of 'depressed' near-term neonates should be started with an oxygen content of less than 100%, and only change to 100% if the child remains bradycardic and cyanotic. A neonate who can be resuscitated with room air will receive no benefit from 100% oxygen and may even have a worse outcome. If the first responder in a pediatric emergency is out of training with pediatric intubation he or she should feel reassured that resuscitation without an attempt at endotracheal intubation is acceptable. Presently, hypothermia in neonates after birth asphyxia should be used within controlled studies, or at least follow the protocols of published studies and be performed in specialized centers.