new guidelines

[galaxy_7]

the new australian neonatal resuscitation guidelines is out in the january/februrary issue of journal of paediatric and child health

New Australian Neonatal Resuscitation guidelines
Colin Morley*

Abstract: New Australian Neonatal Resuscitation Guidelines highlight the recent advances in neonatal resuscitation. Resuscitation should start with air and only use oxygen if the infant does not respond. CPAP and PEEP should be considered for premature infants with meconium stained liquor. Sucking out the mouth and nose is not necessary. Infants less than 28 weeks gestation should be placed in a polyethylene bag or wrap to keep warm. Chest compressions, when required, remain at 3:1 inflation. The endotracheal tube position must be verified with a carbon dioxide detector.

[kpsanghvi]

'Sucking out the mouth and nose is not necessary' is different from saying do not do it. From the abstract it is not clear which suction are they talking about. Is it suction on perineum after delivery of head in meconium stained liquor only or not to suction any baby and clear its airway after delivery.

As for starting resuscitation in room air is a bold step and contrary to the AAP guidelines.

[pooperscooperrn0624]

I assume NRP guidelines are the same there as here in the states, but I am not sure. I am an NRP instructor here and I think what the "not suctioning" is referring to no longer suctioning before delivering of the shoulders during meconium delivery. Also, though I think evidence has proven that PPV on room air is sufficent in most cases at delivery, the AAP isn't wanting to stick its neck out that far. As far as oxygen delivery is concerned- term infants that are cyanotic recommendations of 100% or any time PPV is given. It also states that if O2 isn't available to use PPV on room air (??what other option do we have!).
Recommendations on infants less than 32 weeks is to use a blender and pulse ox begining between 21-100% stating there is no evidence study to recommend particular staring point.

[kpsanghvi]

Hi All

If the Australians and Canadians have stuck their neck out (About starting resuscitation in Room air) why aren' t the Americans doing it.

Are there any guidelines from the European countries.

I am still not convinced about not doing oropharyngeal suctioning at the perineum based on just 1 study. If at all it saves times after the child has been delivered. Would like your comments