Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Newborn resuscitation requires anticipation and preparation by providerswho train individually and as teams.2. Most newly born infants do not require immediate cord clamping or resuscitation and can be evaluated and monitored during skin-to-skin contact with their mothers after birth.3. Inflation and ventilation of the lungs are the priority in newly born infants who need support after birth.4. A rise in heart rate is the most important indicator of effective ventilation and response to resuscitative interventions. 5. Pulse oximetry is used to guide oxygen therapy and meet oxygen saturation goals.6. Chest compressions are provided if there is a poor heart rate response to ventilation after appropriate ventilation corrective steps, which preferably include endotracheal intubation.7. The heart rate response to chest compressions and medications should be monitored electrocardiographically. 8.If the response to chest compressions is poor, it may be reasonable to provide epinephrine, preferably via the intravenous route.9. Failure to respond to epinephrine in a newborn with history or examination consistent with blood loss may require volume expansion.10.If all these steps of resuscitation are effectively completed and there is no heart rate response by 20 minutes, redirection of care should be discussed with the team and family. PREAMBLEIt is estimated that approximately 10% of newly born infants need help to begin breathing at birth, 1-3 and approximately 1% need intensive resuscitative measures to restore cardiorespiratory function.4,5 The neonatal mortality rate in the United States and Canada has fallen from almost 20 per 1000 live births 6,7 in the 1960s to the current rate of approximately 4 per 1000 live births.The inability of newly born infants to establish and sustain adequate or spontaneous respiration contributes significantly to these early deaths and to the burden of adverse neurodevelopmental outcome among survivors.Effective and timely resuscitation at birth could therefore improve neonatal outcomes further.Successful neonatal resuscitation efforts depend on critical actions that must occur in rapid succession to maximize the chances of survival.The International Liaison Committee on Resuscitation (ILCOR) Formula for Survival emphasizes 3 essential components for good resuscitation outcomes: guidelines based on sound resuscitation science, Downloaded from http://ahajournals.org