Resuscitation of the term and premature baby

Although most newly born babies establish normal respiration and circulation without help, up to 1−2% may require some resuscitation or stabilization. Babies who do not establish adequate regular normal breathing or who have a heart rate of less than 100 beats/min or other problems such as prematurity may require assistance. The differences in approach to the resuscitation of such babies originate in the physiology and pathophysiology of acute asphyxia at birth. However, management of airway and breathing remain the key features of resuscitation and where cardiac depression has occurred, this is nearly always due to hypoxia secondary to respiratory compromise. Therefore, most babies will respond within 2−3 min of effective aeration of the lungs and the need for intubation, chest compressions or drugs is rare. The International Liaison Committee on Resuscitation (ILCOR) evaluated evidence in 2000 and 2005 in order to provide guidelines for resuscitation: they will do so again for 2010. This evidence is limited in terms of both quantity and quality and controversies still exist. More research is needed to ensure that our future actions are based upon evidence rather than history. This article will review the recommended approach to resuscitation as well as some newer evidence.