International Liaison Committee on Resuscitation

We know that.

It's well documented in our, um, Australian Resuscitation cal- uh, Council guidelines, in the ILCOR guidelines.

Um, so what do we do with those patients where, um, you know, the LV doesn't sit where our hands are meant to be? What, what is actually happening with that? So we pop down what's called a transesophageal echo probe, which is an ultrasound machine, um, that sits, uh, in the stomach, um, and the heart sits in front of the stomach.

It allows us to see a really good view of the heart without interrupting CPR.

Very, very interesting, um, conversation.

Now, the evidence underpins current recommendations from the ILCOR, um, the International Liaison Committee on Resuscitation, to initiate respiratory support with FiO2 of 20% for the babies who are born after thirty-five weeks.

In contrast, for the neonates who are born before thirty-two weeks, the ILCOR commission mid-analysis found that almost all who commenced respiratory support in the delivery room, um, starting at 21%, ended up using more oxygen by ten minutes of life.

The twenty twenty-five guidelines from ILCOR and from the European Resuscitation Council recommend initiating respiratory support for neonates before thirty-two weeks then with an FiO2 of 30%.

So where's the gap? The gap is what about these babies in between 32 to 35 weeks? There's minimal data that exists for this population specifically.

Four small studies addressing the initial FiO2 have included preterm neonates born up to thirty-five weeks, but most of the participants were all less than thirty-two weeks.

So no published study has targeted optimal initial FiO2 for neonates born between thirty-two and thirty-five weeks of gestation.

ILCOR guidelines currently state that there is insufficient evidence to make recommendations for newborn in this age group, and the lack of evidence is what is leading to inconsistent clinical practice.

Very, very interesting conversation.

Now, the evidence underpins current recommendations from the ILCOR, the International Liaison Committee on Resuscitation, to initiate respiratory support with FIO2 of 21% for the babies who are born after 35 weeks.

In contrast, for the neonates who were born before 32 weeks, the ILCOR Commission mid-analysis found that almost all who commenced respiratory support in the delivery room, starting at 21%, ended up using more oxygen by 10 minutes of life.

The 2025 guidelines from ILCOR and from the European Resuscitation Council recommend initiating respiratory support for neonates before 32 weeks then, with an FiO2 of 30%.

So where's the gap? The gap is what about these babies in between 32 to 35 weeks? There's minimal data that exists for this population specifically.

Four small studies addressing the initial FiO2 have included preterm neonates born up to 35 weeks, but most of the participants were all less than 32 weeks.

Each site crossed over to the use of the alternate initial FIO2 following a one-week washout period.

So they randomized the sites, not the babies.

Et encore une fois, imaginons des enfants qui sont nés de manière prématurée sans le bénéfice de stéroïdes anténataux.

Donc la stratégie, évidemment, on la connaît tous, c'est-à-dire que, euh, ILCOR et, euh, NRP et tout ça, c'est : démarre avec du CPAP.

Du CPAP à 5.

En effet, on est à donc CPAP, évidemment, ça, ça procure une pression continue, euh, qui dis-- qui, euh, qui pro-- qui pro-procure une distension des alvéoles, euh, pendant même l'expiration, qui a été démontrée, euh, de réduire le travail respiratoire et le recours à la ventilation mécanique.