Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Wyckoff, Myra H.; Wyllie, Jonathan; Aziz, Khalid; Almeida, Maria Fernanda de; Fabres, Jorge; Fawke, Joe; Guinsburg, Ruth; Hosono, Shigeharu; Isayama, Tetsuya; Kapadia, Vishal; Kim, Han-Suk; Liley, Helen; McKinlay, Christopher J.D.; Mildenhall, Lindsay; Perlman, Jeffrey M.; Rabi, Yacov; Roehr, Charles Christoph; Schmölzer, Georg M.; Szyld, Edgardo; Trevisanuto, Daniele; Velaphi, Sithembiso; Weiner, Gary M.; Davis, Peter G; Dawson, Jennifer; Ersdal, Hege; Foglia, Elizabeth E.; Kawakami, Mandira Daripa; Lee, Henry; Rüdiger, Mario; Sawyer, Taylor; Soraisham, Amuchou; Strand, Marya; Udaeta, Enrique; Urlesberger, Berndt; Yamada, Nicole K.; Madar, John; Escobedo, Marilyn; Ganguly, Abhrajit; Gately, Callum; Kamath‐Rayne, Beena D.; Mausling, Richard; Domingo-Bates, Jocelyn; Nakwa, Firdose; Ramachandran, Shalini; Ring, Jenny; Shah, Birju A.; Stave, Christopher D; Tamura, Masanori; Pas, Arjan B. te; Cheng, Catherine; El-Naggar, Walid; Finan, Emer; Fuerch, Janene H.; Halamek, L. J.; Kamlin, Omar; Lakshminrusimha, Satyan; McGowan, Jane E.; Niermeyer, Susan; Quek, Bin Huey; Singhal, Nalini; Testoni, Daniela

doi:10.1161/cir.0000000000000895

Cited by 232 publications

(278 citation statements)

References 143 publications

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“…27 There is no evidence of maternal harm from delayed cord clamping compared with early cord clamping. [10][11][12][28][29][30][31][32][33][34] Cord milking is being studied as an alternative to delayed cord clamping but should be avoided in babies less than 28 weeks' gestational age, because it is associated with brain injury. 23…”

Section: Synopsismentioning

confidence: 99%

“…8 Ten RCTs found no difference in postpartum hemorrhage rates with delayed cord clamping versus early cord clamping. [10][11][12][28][29][30][31][32][33][34] 2. Compared with term infants receiving early cord clamping, term infants receiving delayed cord clamping had increased hemoglobin concentration within the first 24 hours and increased ferritin concentration in the first 3 to 6 months in meta-analyses of 12 and 6 RCTs, 9-21 respectively.…”

Section: Recommendation-specific Supportive Textmentioning

confidence: 99%

“…Compared with term and late preterm infants receiving early cord clamping, those receiving delayed cord clamping showed no significant difference in mortality, admission to the neonatal intensive care unit, or hyperbilirubinemia leading to phototherapy in metaanalyses of 4, 10,13,29,35 10, 10,12,17,19,21,28,31,34,36,37 and 15 RCTs, respectively. 9,12,14,[18][19][20][21][28][29][30][32][33][34]38,39 Compared with term infants receiving early cord clamping, those receiving delayed cord clamping had increased polycythemia in metaanalyses of 13 10,11,13,14,17,18,21,29,30,33,[39][40][41] and 8 RCTs, 9,10,13,19,20,28,30,34 respectively.…”

Section: Recommendation-specific Supportive Textmentioning

confidence: 99%

“…The potential benefit or harm of sustained inflations between 1 and 10 seconds is uncertain. 2,29 Recommendation-Specific Supportive Text 1. Providing PPV at a rate of 40 to 60 inflations per minute is based on expert opinion.…”

Section: Synopsismentioning

confidence: 99%

“…2 3. Two systematic reviews 29,30 in preterm newborns (low to moderate certainty) found no significant benefit from sustained lung inflation over PPV; one review found a higher risk of death in the first 48 hours. One large RCT 31 was stopped early when an increased rate of early mortality was identified in babies less than 28 weeks' gestational age who received sustained inflations; no significant difference was found in the primary outcome of death or bronchopulmonary dysplasia.…”

Section: Synopsismentioning

confidence: 99%

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

Aziz¹,

Lee²,

Escobedo³

et al. 2021

Pediatrics

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103

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This article has been copublished in Circulation. This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.

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Section: Synopsismentioning

confidence: 99%

Section: Recommendation-specific Supportive Textmentioning

confidence: 99%

Section: Recommendation-specific Supportive Textmentioning

confidence: 99%

Section: Synopsismentioning

confidence: 99%

Section: Synopsismentioning

confidence: 99%

See 3 more Smart Citations

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

Aziz¹,

Lee²,

Escobedo³

et al. 2021

Pediatrics

Self Cite

103

View full text Add to dashboard Cite

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Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm

Ehrhardt,

Aubert,

Ådén

et al. 2023

JAMA Netw Open

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ImportanceThe Apgar score is used worldwide as an assessment tool to estimate the vitality of newborns in their first minutes of life. Its applicability to estimate neurodevelopmental outcomes in infants born extremely preterm (EPT; &lt;28 weeks’ gestation) is not well established.ObjectiveTo investigate the association between the Apgar score and neurodevelopmental outcomes in infants born EPT.Design, Setting, and ParticipantsThis cohort study was conducted using data from the Effective Perinatal Intensive Care in Europe-Screening to Improve Health in Very Preterm Infants in Europe (EPICE-SHIPS) study, a population-based cohort in 19 regions of 11 European countries in 2011 to 2012. Clinical assessments of cognition and motor function at age 5 years were performed in infants born EPT and analyzed in January to July 2023.ExposuresApgar score at 5 minutes of life categorized into 4 groups (0-3, 4-6, 7-8, and 9-10 points).Main Outcomes and MeasuresCognitive and motor outcomes were assessed using the Wechsler Preschool and Primary Scale of Intelligence test of IQ derived from locally normed versions by country and the Movement Assessment Battery for Children–Second Edition. Parents additionally provided information on communication and problem-solving skills using the Ages and Stages Questionnaire, third edition (ASQ-3). All outcomes were measured as continuous variables.ResultsFrom the total cohort of 4395 infants born EPT, 2522 infants were live born, 1654 infants survived to age 5 years, and 996 infants (478 females [48.0%]) followed up had at least 1 of 3 outcome measures. After adjusting for sociodemographic variables, perinatal factors, and severe neonatal morbidities, there was no association of Apgar score with IQ, even for scores of 3 or less (β = −3.3; 95% CI, −10.5 to 3.8) compared with the score 9 to 10 category. Similarly, no association was found for ASQ-3 (β = −2.1; 95% CI, −24.6 to 20.4). Congruent results for Apgar scores of 3 or less were obtained for motor function scores for all children (β = −4.0; 95% CI, −20.1 to 12.1) and excluding children with a diagnosis of cerebral palsy (β = 0.8, 95% CI −11.7 to 13.3).Conclusions and RelevanceThis study found that low Apgar scores were not associated with longer-term outcomes in infants born EPT. This finding may be associated with high interobserver variability in Apgar scoring, reduced vitality signs and poorer responses to resuscitation after birth among infants born EPT, and the association of more deleterious exposures in the neonatal intensive care unit or of socioeconomic factors with greater changes in outcomes during the first 5 years of life.

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Comparison of Respiratory Support After Delivery in Infants Born Before 28 Weeks’ Gestational Age

Donaldsson

Drevhammar

et al. 2021

JAMA Pediatr

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IMPORTANCEEstablishing stable breathing is a key event for preterm infants after birth. Delivery of pressure-stable continuous positive airway pressure and avoiding face mask use could be of importance in the delivery room.OBJECTIVE To determine whether using a new respiratory support system with low imposed work of breathing and short binasal prongs decreases delivery room intubations or death compared with a standard T-piece system with a face mask. DESIGN, SETTING, AND PARTICIPANTSIn this unblinded randomized clinical trial, mothers threatening preterm delivery before week 28 of gestation were screened. A total of 365 mothers were enrolled, and 250 infants were randomized before birth and 246 liveborn infants were treated. The trial was conducted in 7 neonatal intensive care units in 5 European countries from March 2016 to May 2020. The follow-up period was 72 hours after intervention.INTERVENTIONS Infants were randomized to either the new respiratory support system with short binasal prongs (n = 124 infants) or the standard T-piece system with face mask (n = 122 infants). The intervention was providing continuous positive airway pressure for 10 to 30 minutes and positive pressure ventilation, if needed, with the randomized system. MAIN OUTCOMES AND MEASURESThe primary outcome was delivery room intubation or death within 30 minutes of birth. Secondary outcomes included respiratory and safety variables. RESULTSOf 246 liveborn infants treated, the mean (SD) gestational age was 25.9 (1.3) weeks, and 127 (51.6%) were female. A total of 41 infants (33.1%) receiving the new respiratory support system were intubated or died in the delivery room compared with 55 infants (45.1%) receiving standard care. The adjusted odds ratio was statistically significant after adjusting for stratification variables (adjusted odds ratio, 0.53; 95% CI, 0.30-0.94; P = .03). No significant differences were seen in secondary outcomes or safety variables. CONCLUSIONS AND RELEVANCEIn this study, using the new respiratory support system reduced delivery room intubation in extremely preterm infants. Stabilizing preterm infants with a system that has low imposed work of breathing and binasal prongs as interface is safe and feasible.

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Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Cited by 232 publications

References 143 publications

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

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

Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm

Comparison of Respiratory Support After Delivery in Infants Born Before 28 Weeks’ Gestational Age

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