New Neonatal Resuscitation Guidelines Published

The American Heart Association has published the 2020 Guidelines for Cardiovascular Care and Emergency Cardiac Care: Part 5: Neonatal Resuscitation. The Neonatal Resuscitation Program will base revisions on these guidelines. These guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for neonatal life support published by the International Liaison Committee on Resuscitation (ILCOR). Both are co-published in the November 2020 editions of Pediatrics and Circulation. The previous guidelines and CoSTR on neonatal life support were published in 2015.

What you need to know:

There are no major changes in the 2020 guidelines for neonatal resuscitation. Half of the updated recommendations are actually a stronger emphasis on previous recommendations. The neonatal resuscitation algorithm remains unchanged.

The updated 2020 neonatal resuscitation recommendations are as follows:

  • Tracheal intubation and suction of nonvigorous meconium-stained newborns: Stronger recommendation against routine intratracheal suctioning
  • Epinephrine: Minor editorial revisions and more specific dose information and guidance about repeat doses were included. A systematic review on epinephrine administration was published in October 2020.
  • Intraosseous versus umbilical vein for emergency access: Stronger support for the use of the umbilical vein for vascular access, but recognizing that IO route is still acceptable
  • Impact of duration of intensive resuscitation: There is no evidence that any specific duration of resuscitation consistently predicts mortality or moderate-to-severe neurodevelopmental impairment. The clinical team and family should partake in discussion to discontinue prolonged resuscitative efforts. A reasonable time frame to consider this change in goals of care is around 20 minutes after birth.

Topics reviewed with NO CHANGES OR ADDITION to previous recommendations

The following topics were reviewed and did not lead to changes in recommendations. However, current evidence on these topics is reviewed thoroughly in the CoSTR.

Anticipation and Preparation
• Prediction of need of respiratory support in the delivery room
• Effect of briefing/debriefing following neonatal resuscitation
Initial Assessment and Intervention
• Warming adjuncts
• Suctioning of clear fluid
Physiological Monitoring and Feedback Devices
• Heart rate monitoring during neonatal resuscitation
Ventilation and Oxygenation
• Sustained inflation
• Positive end-expiratory pressure (PEEP) versus no PEEP
• Continuous positive airway pressure (CPAP) versus intermittent PPV
• T-piece resuscitator versus self-inflating bag for ventilation
• Oxygen for preterm or term resuscitation (unchanged from 2019 focused update)
Circulatory Support
• CPR ratios for neonatal resuscitation
• 2-thumb versus 2-finger compressions for neonatal resuscitation
Drug and Fluid Administration
• Volume infusion during neonatal resuscitation
• Sodium bicarbonate during neonatal resuscitation
Postresuscitation Care
• Rewarming of hypothermic newborns
• Induced hypothermia in settings with limited resources
• Postresuscitation glucose management

Sources: Aziz K, Lee HC, Escobedo MB, et al. Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2020; doi: 10.1542/peds.2020-038505E. Accessed 10/22/2020

Wyckoff MH, Weiner GM, et al. Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Pediatrics. 2020; doi: 10.1542/peds.2020-038505C . Accessed 10/22/2020