Neonatal Resuscitation with Dr. Tricia Swan

What are the things that, the take-home things that we as physician, emergency physicians, community emergency physicians need to see as the things that are going to be different than what we had before?

So the first big one is cord clamping.

Cord clamping wasn't initially part of the NRP algorithm.

There's been some good data about cord clamping and cord milking.

So now at the very top of the algorithm, right after birth, there is a consideration of cord management.

And what that really means is for babies who are born full term and are vigorous and don't show signs of needing full resuscitation immediately, that we can actually delay cord clamping for up to 60 seconds.

Previous versions had been about 30 seconds of consideration, but this has really made an emphasis on cord management.

So you can delay up to 60 seconds before you clamp the cord.

That allows more transfer of good blood products to baby and then clamp the cord in a vigorous baby.

If the baby is born and does show signs of needing resuscitation, then there is the concept of cord milking.

So in a full-term baby, all the way down to 32 weeks, you can actually milk the cord three times towards the baby to transfer quickly some of that blood product before you clamp it off.

There is some data in between the 32 weeks and the 28 weeks.

We're not sure if there's any benefit, so it can be considered.

at the extremely preterm birth at 28 weeks and below, cord milking is not indicated.

So we shouldn't cord milk anything below 28 weeks.

That just has to do with intraventricular hemorrhage risk.

So that was the first big emphasis and it was actually put into the algorithm this year is to have a cord management plan.

Some of the other big changes were to FiO2.

So FiO2 is really important consideration whenever you are moving on to the positive pressure ventilation.

So if you're moving into resuscitation efforts and you're providing the positive pressure ventilation.

You want to keep your FiO2 at room air for babies that are 35 weeks and above.

FiO2, 100% FiO2 is really harmful for newborns and the other part is that the algorithm actually moved to not even checking an O2 sat until two minutes into the resuscitation process.

And we have time to get their SATs up.

So your initial SATs at two minutes is acceptable at 75%, or 65%, excuse me.

So you can actually, you have time to give breaths with room air on those babies that are born full term.

What are the things that, the take-home things that we as physician, emergency physicians, community emergency physicians need to see as the things that are going to be different than what we had before?

So the first big one is cord clamping.

Cord clamping wasn't initially part of the NRP algorithm.

There's been some good data about cord clamping and cord milking.

So now at the very top of the algorithm, right after birth, there is a consideration of cord management.

And what that really means is for babies who are born full term and are vigorous and don't show signs of needing full resuscitation immediately, that we can actually delay cord clamping for up to 60 seconds.

Previous versions had been about 30 seconds of consideration, but this has really made an emphasis on cord management.

So you can delay up to 60 seconds before you clamp the cord.

That allows more transfer of good blood products to baby and then clamp the cord in a vigorous baby.

If the baby is born and does show signs of needing resuscitation, then there is the concept of cord milking.

So in a full-term baby, all the way down to 32 weeks, you can actually milk the cord three times towards the baby to transfer quickly some of that blood product before you clamp it off.

There is some data in between the 32 weeks and the 28 weeks.

We're not sure if there's any benefit, so it can be considered.

at the extremely preterm birth at 28 weeks and below, cord milking is not indicated.

So we shouldn't cord milk anything below 28 weeks.

That just has to do with intraventricular hemorrhage risk.

So that was the first big emphasis and it was actually put into the algorithm this year is to have a cord management plan.

Some of the other big changes were to FiO2.

So FiO2 is really important consideration whenever you are moving on to the positive pressure ventilation.

So if you're moving into resuscitation efforts and you're providing the positive pressure ventilation.

You want to keep your FiO2 at room air for babies that are 35 weeks and above.

FiO2, 100% FiO2 is really harmful for newborns and the other part is that the algorithm actually moved to not even checking an O2 sat until two minutes into the resuscitation process.

And we have time to get their SATs up.

So your initial SATs at two minutes is acceptable at 75%, or 65%, excuse me.

So you can actually, you have time to give breaths with room air on those babies that are born full term.