Delivery Room Management of the VLBW Infant

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This toolkit is designed to provide guidelines for the resuscitation of all infants following delivery using the best information available to date. We believe that the smallest and most immature of infants have unique requirements to ensure an effective transition from fetal to extra-uterine life. These infants have immature organ systems, and without appropriate preparation and intervention can develop severe degrees of hypothermia, and respiratory failure that can significantly increase mortality and morbidity. At the other end of the spectrum, many full-term infants will experience difficulties following delivery, and the basic principles of resuscitation can be applied in a similar fashion for all newborns infants for all gestational ages.

Previous resuscitation guidelines (American Heart Association 2005), while having sections discussing specific issues of prematurity, have not been designed for the most immature of infants. For these infants resuscitation interventions are required more frequently with an almost 100 fold increase in the need for compressions or epinephrine when compared with the term infant (Finer, 1999a, Finer 1999b, Wyckoff 2005). The new guidelines, as reflected in the 6th Edition of NRP and discussed by Kattwinkel et al and Perlman et al reflecting the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations, have expanded sections on the resuscitation requirements and interventions for the preterm infant.i iiThese areas include the recommended use of oximeters and a targeted oxygen strategy to gradually increase the SpO2 for intrauterine values to acceptable neonatal values over at least the first 10 minutes of life using the most appropriate FiO2; this requires the use of air and an oxygen blender.

While there remains a dearth of prospective research on actual resuscitation interventions for VLBW infants there is some evidence regarding the optimal resuscitation environment and a number of effective practices that can assist in stabilizing VLBW infants.

A guiding principle of this toolkit is that whenever possible/feasible, the delivery room/resuscitation room environment should mimic as closely as possible that of the Neonatal Intensive Care Unit, and that every effort should be made to establish homeostasis as soon as possible after birth for all newborn infants.