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BackgroundGuidelines advise for more than 20 years to use occlusive plastic wraps for temperature management during delivery room care but data on efficacy of different types of wrap are still scarce.MethodsA random sample of seven different types of plastic wrap was tested using prewarmed aluminium blocks.ResultsThe most effective wrap increased the time to cool by 2°C by one-third for the core and by 100% for the surface whereas the least effective wrap led to even faster heat loss compared with no wrap at all. The least effective wrap concerning all capacities tested was made from polyurethane that contains potentially toxic and narcotic monomers. Heat and water retention did not correlate to wrap thickness.DiscussionLarge differences in heat and water retention capacity warrant a careful choice of the type of wrap as some might be counterproductive. Wraps containing polyurethane should not be used.

Objective To assess feasibility, safety, usability and learnability of delivery room care and resuscitation with intact placental circulation (RIPC) at mother's bedside. Materials and methods We included neonates ≥24 weeks GA after parental consent. Both in vigorous and babies requiring resuscitation, appropriate steps of resuscitation were provided with intact cord till 3 min using RIPC warmer. Outcomes were assessed by set criteria and standard system usability scale. Results Of 380 enrolled, intervention was feasible in 376 babies (98.9%). Safety criteria were met in all 376 babies received onto the trolley (100%). Median GA was 38 (37-39) weeks and median BW 2740 (2330-3120) g. Of 376, 92 required resuscitation; 90 (97.8%) PPV, 49 (53.2%) intubations and 13 (14.1%) chest compressions. System Usability Score rated >68 (good) in 90% and 52-68 (fair) in 10%. Temperature at 5 min was 36.5 ± 0.1. Conclusions Delivery room care and neonatal RIPC is feasible and safe across gestations.

In October 2019, the British Association of Perinatal Medicine (BAPM) published a Framework1 and associated infographic2 for ‘Practice on Perinatal Management of Extreme Preterm Birth Before 27 Weeks of Gestation’. This outlined an approach, based on data from the UK and abroad, to assist clinicians in decision-making relating to perinatal care at ≤26+6 weeks gestation. Many frontline providers of delivery room care of extremely preterm infants will have completed a Resuscitation Council UK (RCUK) Newborn Life Support or Advanced Resuscitation of the Newborn Infant course. This RCUK response to the BAPM Framework highlights how this might impact on their approach.

Precise characterization of cardiac anatomy and physiology through fetal echocardiography can predict early postnatal clinical course. Some neonates with prenatally defined critical congenital heart disease have anticipated precipitous compromise during perinatal transition for which specialized, diagnosis-specific delivery room care can be arranged to expeditiously stabilize cardiopulmonary hemodynamics. In this article, we describe our institutional approach to the delivery room care of neonates with prenatally diagnosed congenital heart disease, emphasizing our diagnosis-specific care pathways for newborns with critical disease.

The following guideline is designed to give recommendations for the routine care of all neonates immediately after delivery, and the resuscitation and delivery room approach of all high-risk infants in light of recent literature. The guideline has been prepared as three different parts. The first part is about routine procedures that have to be performed to all healthy term and preterm infants in delivery room care. The second part summaries the basic principles of resusucitation including the latest changes that were mentioned in the International Liaison Committee on Resuscitation (ILCOR)-2015 guideline. Recommendations about the delivery room management of rare clinical conditions have been discussed in the last part. The social, medical conditions, and the resourses of Turkey have also been taken into consideration in its preparation. We hope it will be useful for all pediatricians and neonatologists for use as a essential guideline in delivery room care.

This clinical scenario-based review will discuss how telehealth programs improve access to specialty care for neonates, their caregivers, and primary care pediatricians. Tele-resuscitation supports pediatricians during complex, high-risk newborn resuscitations, improves the quality of delivery room care, and reduces odds of transfer to a higher level of care. Neonatologists and other pediatric specialists use telehealth to provide more effective consultations that positively influence management decisions and patient outcomes. When neonatologists provide video visits to home and meet virtually with primary care pediatricians, infants discharged from the NICU experience fewer emergency room visits and hospital re-admissions. With further implementation and dissemination of neonatal telemedicine programs, it is important that these programs continue to be thoughtfully designed to achieve measurable value that is relevant to patients and caregivers, providers, healthcare systems, and payers.

While optimal antenatal care is provided for the mother to improve survival of newborn babies, appropriate should be given to the babies. The most important time period in delivery room management is the first minute which is named as “first golden minute”. Within this period, body temperature of the baby should be checked , patency of its airway, its respiratory and heart rate should be assesed, first breath should be initiated in case of need, and saturation must be measured objectively using a pulse oximeter. Excessive and unnecessary use of oxygen should be prevented by considering targeted saturation values which are determined according to the time passed after birth. Recent studies showed that 30-60 seconds delay in umbilical cord clamping time will lead to higher hemoglobin concentrations and iron stores in newborns. Preterm babies who may need ventilatory support should be put on continuous positive airway pressure (CPAP) even from the first breath which will decrease the need for intubation and surfactant administration. Prophylactic administration of surfactant in preterm newborns is being abandoned today, surfactant should only be given to preterm newborns in need. Nowadays, less invasive administration of surfactant (LISA) is being tested. If resuscitation is needed oxygen support should be started with 21% saturated oxygen in newborns at or above 35th gestational age. If the gestational age is less than 35th weeks, 21-30% saturated oxygen should be given at the beginning then, oxygen support should be increased up to targeted saturation levels in a controlled manner.

For more than half a century neonatologists and ethicists alike have struggled with ethical dilemmas surrounding infants born at the limits of viability. Both doctors and parents face difficult decisions. Do we try to save these babies, knowing that such efforts are likely to be unsuccessful? Or do we provide only comfort care, knowing that, in doing so, you will inevitably allow some babies to die who might have been saved? In this paper, we review the outcome data on these babies and offer ten suggestions for doctors: (1) accept that there is a 'gray zone' during which decisions are not black and white; (2) do not place too much emphasis on gestational age; (3) dying is generally not in an infant's best interest; (4) impairment does not necessarily equal poor quality of life; (5) just because the train has left the station doesn't mean you can't get off; (6) respect powerful emotions; (7) be aware of the self-fulfilling prophecies; (8) time lag likely skews all outcome data; (9) statistics can be both confused and confusing; (10) never abandon parents.

The first hour of a newborn’s life is fraught with difficulty. Recommendations regarding the fundamental issues of resuscitation of these infants are developed and disseminated by the International Liaison Committee on Resuscitation and other organizations. However, these recommendations frequently do not address the needs of the very low birth weight infant and do not address some of the nuances that might lead to improved outcome. Improved organization and teamwork as well as improved monitoring and respiratory support can potentially improve the outcome of these infants.

Fetal life evolves in a low oxygen milieu as compared to the extra-uterine. In the fetal to neonatal transition rapid changes in the oxygen content of the newly born infant occur within a brief period of time. Delivery room care givers should be aware of the slow transition regarding oxygenation, and supply oxygen as needed trying to avoid damage caused by hyper-and-hypoxia. In this regard, titrating oxygen inspiratory fraction against oxygen saturation as measured by pulse oximetry following recent nomogram ranges is a valid method.

Advances in perinatal care have been accompanied by improved survival among infants born in the middle to late second trimester, who were previously considered nonviable. This development has led to the spurious assumption that life can be sustained in live-born infants irrespective of gestational age or birth weight. Since pessimism prevails in the few reports on later outcomes among these very small and immature infants, the indiscriminate initiation of intensive care raises many philosophical, ethical, and economic questions.1 2 3 4 5 6 7 8 9 10 Despite many reviews with titles such as "How Small Is Too Small?,"11 "What Is the Lower Limit of Viability?,"12 and "Where and . . .

Neonatal survival of very low birth weight (VLBW) infants (600-999 grams) and long-term outcome of low birth weight (LBW) infants (600-1499 grams) are correlated with optimal delivery room (DR) management. Over a 4-year period, 335 LBW infants were born alive at UCHSC. Of these, 108 were VLBW. Intrapartum and resuscitation management were reviewed and rated. "Optimal delivery care" was defined as appropriate intrapartum care and a controlled, uncomplicated delivery. "Optimal resuscitation" required that a team be present at delivery and encounter no technical problems. Optimal delivery room (DR) management occurred when both obstetric and pediatric care were appropriate. Adequate information was available to rate 80% of cases. Survival of VLBW infants was significantly improved with optimal DR care (p < 0.05). DR care had the greatest impact on 700-999 grams infants. In this group, 68% of survivors had "optimal care" while only 31% of the neonatal deaths (ND) had "optimal care" (p < 0.01). Neonatal deaths also occurred later with optimal DR care (p < 0.02). Unavoidable obstetrical complications occurred in 14 deliveries of VLBW infants (11 ND and 3 survivors) (p < 0.05). All of the survivors had optimal resuscitation. Only 1 of the 3 survivors was normal at follow-up. Vaginal breech delivery of LBW infants had a significant neonatal mortality compared to vertex vaginal delivery (p < 0.01) or breech C-section delivery (p < 0.02). Optimal DR management was also associated with normal long-term outcome for LBW infants. Fifty percent with optimal DR care and 30% without were normal at follow-up (p < 0.05). With improvement in Newborn Intensive Care, the effects of intrapartum and delivery room management can now be measured in both neonatal survival and long-term outcome. These findings have special significance for level I hospitals who transport LBW infants after delivery and stabilization.