Perinatal Physiology and Principles of Neonatal Resuscitation

Successful transition at birth is dependent on establishment of the lungs as the organ of gas exchange. The objective of this review is to provide a general overview of the events during transition at birth, pathophysiology of asphyxia, and response to resuscitation. The basic steps of neonatal resuscitation are establishment of airway, ventilation, and circulatory support. The controversy about the use of room air vs oxygen at birth for resuscitation is discussed. Special conditions that may be encountered during neonatal resuscitation include choanal atresia, pneumothorax, diaphragmatic hernia, meconium aspiration, and anemia. Finally, guidelines for discontinuing, withdrawing, and withholding resuscitative efforts are reviewed.