Reprint: The American Heart Association requests that this document be cited as follows: Perlman JM, Wyllie J, Kattwinkel J, Wyckoff MH, Aziz K, Guinsburg R, Kim HS, Liley HG, Mildenhall L, Simon WM, Szyld E, Tamura M, Velaphi S; on behalf of the Neonatal Resuscitation Chapter Collaborators. Part 7: neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015;132(suppl 1):S204–S241.
Reprinted with permission of the American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on Resuscitation. This article has been published in Circulation and Resuscitation.
(Circulation. 2015;132[suppl 1]:S204–S241. DOI: 10.1161/CIR.0000000000000276.)
The transition from intrauterine to extrauterine life that occurs at the time of birth requires timely anatomic and physiologic adjustments to achieve the conversion from placental gas exchange to pulmonary respiration. This transition is brought about by initiation of air breathing and cessation of the placental circulation. Air...
Response to Comment
12 January 2016
2015 Guidelines for Neonatal Resuscitation: Does the Algorithm Require a Modification? Submitted by Stefano Ghirardello, Simone Pratesi, Fabio Mosca, Carlo Dani
Response to Comment submitted by Gary M Weiner, Myra Wyckoff, John Kattwinkel, Jeffrey M Perlman
We believe that the authors of the above comment have misinterpreted the ILCOR and AAP/AHA neonatal flow-diagrams and text and, also, misrepresent the ERC’s guidelines.
The AHA/AAP neonatal guidelines flow-diagram indicates that if the provider perceives that the baby had labored breathing or is persistently cyanotic, he/she should use pulse oximetry to check oxygen saturation and use supplementary oxygen as indicated (to achieve the saturation guidelines). The ILCOR flow-diagram does address persistent cyanosis.
While it is true that the ERC chose not to address what a provider should do when faced with persistent cyanosis in its neonatal guidelines flow-diagram, the ERC provides the same guidance within the text “Although colour is a poor method of judging oxygenation, it should not be ignored: if a baby appears blue, check preductal oxygenation with a pulse oximeter.”
We hope this explanation offers clarity.
REFERENCES
1) Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: Neonatal Resuscitation. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132 (Suppl 2): S543-60.
2) Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015 Section 7. Resuscitation and support of transition of babies at birth. Resuscitation 2015;95:249–263
We read with interest the Wyckoff et al article on the 2015 Guidelines for Neonatal Resuscitation (1). According to the ILCOR neonatal resuscitation algorithm, a newly born presenting “persistent cyanosis” without labored breathing within the first minute of life should be actively assisted with supplementary oxygen or positive pressure support, on the basis of pulse-oximetry (SpO2) and targeted preductal saturations. We believe that an early, isolated “persistent cyanosis” should no longer be considered a clinical sign to guide resuscitation, as it could be misinterpreted, leading to overmedication in terms of oxygen use and respiratory support, particularly in preterm newborns, where targeted preductal SpO2 at three minutes of life is expected around 70-75%, a percentage where cyanosis is still present. Furthermore, persistent cyanosis does not appear in the algorithm proposed by Wyllie et al (2), and this could lead to misinterpretation.
Therefore, we suggest that this part of the algorithm be changed by eliminating “persistent cyanosis” from the box of the figure (“Labored breathing or persistent cyanosis”).
REFERENCES
1) Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: Neonatal Resuscitation. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132 (Suppl 2): S543-60.
2) Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015 Section 7. Resuscitation and support of transition of babies at birth. Resuscitation 2015;95:249–263