Session Title: NRP Current Issues Seminar

Session Number: C0006Myra H. Wyckoff, MD, FAAPUT Southwestern Medical Center at Dallas

Update on the International Liaison Committee on Resuscitation (ILCOR)

The 2015 Scientific Review is almost here!

Faculty Disclosure Information

In the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of

commercial services discussed in this CME activity.

I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

Achieving Consensus on Resuscitation Science

Since 2000, the AAP with the American Heart Association, participates with the International Liaison Committee on Resuscitation (ILCOR) for a complete review of resuscitation science every 5 years.

32 new questions being reviewed for 2015Australian

ResuscitationCouncil

ILCOR 2010 Neonatal Working Group

Guidelines for Neonatal Resuscitation Guidelines available online

October 19, 2015

Printed Guidelines supplement will be published in Circulation, Resuscitation and likely Pediatrics

Will be able to download at: www.heart.org/cpr

NRP Guidelines are set by the AAP NRP Steering Committee

Circulatory SupportCompression/Ventilation ratios2 Thumb vs 2 Finger CPREpinephrine dosingIO vs IVIV vs ETT drugsNaloxoneSodium BicarbonateVolume ResuscitationSupportive Therapy

Warming Adjuncts

Teaching ResuscitationHigh fidelity trainingImpact of debriefing on team performance

Ventilation StrategiesCPAP and IPPVLMAComparing IPPV devicesVentilation parameters for neonates

Monitoring During and After IntubationBradycardia and CO2 monitoringCO2 detectionVentilation volume monitoring

Postresuscitation ManagementHypothermia (induced)Maternal feverSupplemental glucose

Initial Assessment and InterventionCO2 detector, pulse oximetryO2 use during resuscitationO2 saturation targetsMeconium stained amniotic fluidUmbilical Cord ClampingPrenatal prediction of respiratory compromise

Withholding or Stopping Resuscitation Efforts Duration of CPR with asystole and outcome Futile resuscitation rules

Circulatory SupportCompression/Vent ratios2 Thumb vs 2 Finger CPREpinephrine dosingIO vs IVIV vs ETT drugsNaloxoneSodium BicarbonateVolume Resuscitation

Supportive TherapyWarming AdjunctsImpact of Maternal TempImpact of HypothermiaImpact of Hyperthermia

Teaching ResuscitationFrequency of trainingImpact of debriefing on team performance

Ventilation StrategiesCPAP and IPPVLMAComparing IPPV devicesPEEP vs no PEEPSustained Inflation

Monitoring During and After IntubationBradycardia and CO2 monitoringCO2 detectionVentilation volume monitoring

Postresuscitation ManagementHypothermia (induced)Maternal feverSupplemental glucose

Initial Assessment and InterventionCO2 detector, pulse oximetryO2 use during CPRO2 saturation targets for pretermsMeconium suctioning of the non- vigorous infantsUmbilical Cord Clamping for non- vigorous infantsPrenatal prediction of respiratory compromise

Withholding or Stopping Resuscitation Efforts Apgar score of 0 at 10 minutes Futile resuscitation

Hot Topics in Neonatal Resuscitation Should cord clamping be delayed for neonates

who are non-vigorous? How to best maintain euthermia of the neonate in

the delivery room?

Does intubation and suction benefit the non-vigorous meconium stained neonate?

How should oxygen be used for premature neonates in the delivery room?

How to deliver initial breaths to a premature neonate in the delivery room?

Handling of the Cord In preterm neonates including those who require resuscitation

does delayed cord clamping versus immediate cord clamping improve outcome?

In very preterm infants does milking the cord versus immediate clamping improve outcomes?

Temperature Management in the DR

In non-asphyxiated babies at birth, does maintenance of normothermia (Core temp>=36.5 degrees and <=37.5 degrees centigrade) from delivery to admission, compared with hypothermia (< 36ºC) or hyperthermic (> 37.5ºC), change outcome.

Among preterm neonates who are under radiant warmers in the hospital, does increased room temperature, thermal mattress, or another intervention, compared with plastic wraps alone, change outcome?

77 F

Suctioning of the Non-vigorous Meconium Stained Infant

Does suctioning of the trachea improve outcomes (prevent meconium aspiration syndrome, etc.) for non-vigorous meconium stained infants?

Handling of the Cord In preterm neonates including those who require resuscitation

does delayed cord clamping versus immediate cord clamping improve outcome?

In very preterm infants does milking the cord versus immediate clamping improve outcomes?

Delivery Room O2

Among preterm newborns (< 37 wks GA) who receive PPV in the delivery room, does low initial oxygen (21-30%) as opposed to high initial high oxygen (80-100%) decrease mortality, BPD, ROP, neurologic deficit, time to HR > 100 bpm

How to Deliver Initial Breaths to a Preterm Infant in the DR

In term/preterm newborn infants who do not establish spontaneous respiration at birth, does the administration of one or more pressure-limited sustained lung inflations lasting 15-30s as compared to intermittent positive pressure ventilation with short inspiratory times (< 1s) for 30-60s improve outcome?

Great News! There is lots of new science to review and

incorporate into the new ILCOR guidelines!

Ackowledgments Thanks to the AAP for several of the

photos used for illustration