Newborn Resuscitation and the Lung

Approximately 10% of newborns require some assistance to begin breathing at birth. The lung plays a central role in neonatal resuscitation. Rapid clearance of lung fluid and a tenfold increase in pulmonary blood flow caused by a dramatic fall in pulmonary vascular resistance are essential for gas exchange. Failure to make a smooth transition from fetal to neonatal life leads to a need for resuscitation at birth. Traditionally, babies have been resuscitated using 100% oxygen, but evidence now suggests that use of 100% oxygen during resuscitation may be harmful, and excessive use of oxygen, therefore, should be avoided. Pulse oximetry may help to guide inspired oxygen delivery. Effective ventilation is the key to successful neonatal resuscitation. Because excessive tidal volumes and pressures cause lung injury, the minimal inflation required to achieve an increase in heart rate should be used. In preterm babies, starting resuscitation with continuous positive airway pressure or positive end-expiratory pressure may help to improve oxygenation, stabilize the airway, and establish functional residual volume. As a result of recent studies, the recommendations for the care of meconium-stained infants have been changed; routine intrapartum suctioning of such infants no is longer recommended. Meconium-stained, depressed infants should receive intratracheal suctioning immediately after birth and before stimulation, but tracheal suctioning is not necessary for vigorous babies who have meconium-stained amniotic fluid.