| KÄYPÄ HOITO -SUOSITUKSESSA KÄSITELTY AIHE | ILCOR: Consensus of Science with treatment recommendations (CoSTR) «https://costr.ilcor.org/»1 |
Recommendation/Evidence (GRADE) | |
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| Elvytykseen varautuminen | Prediction of need of respiratory support in the delivery room (NLS 611 (2010); EvUp S189 2020 «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 | When an infant without antenatally identified riskfactors is delivered at term by cesarean delivery under regional anesthesia, a provider capable of performing assisted ventilation should be present at the delivery. It is not necessary for a provider skilled in neonatal intubationto be present at that delivery. | |
| Effect of Briefing and Debriefing Following Neonatal Resuscitation on Patient/Clinician/Parent
Outcomes (NLS #1562) 2/2020 4/2021 «Fawke J, Stave C, Yamada N. Use of briefing and de...»1 «https://costr.ilcor.org/document/effect-of-briefing-and-debriefing-following-neonatal-resuscitation-on-patient-clinician-parent-outcomes-nls-1562-scoping-review»3 |
We conclude that briefing or debriefing may improve short-term clinical and performance outcomes for infants and staff. The effects of briefing or debriefing on long-term clinical and performance outcomes are uncertain. | ||
| Elvytyskoulutus | Team and leadership training (EIT #631): Systematic Review 1/2020 4/2021 |
We suggest that specific team and leadership training be included as part of Advanced Life Support training for healthcare providers |
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| Resuscitation training frequency (NRP 859) | We suggest that training should be recurrent and considered more frequently than once per year. This retraining may be composed of specific tasks and/or behavioral skills, depending on the needs of the trainees |
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| Lämpötalous | Maintaining infant temperature during delivery room resuscitation (NRP 599/2015; EvUp 2020) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 | Among newborn preterm infants of less than 32weeks' gestation under radiant warmers in the hospital delivery room, we suggest using a combination of interventions that may include environmental temperature 23°C to 25°C, warm blankets, plastic wrapping without drying, cap, and thermal mattress to reduce hypothermia (temperature less than 36.0°C) on admission to NICU |
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| We suggest that hyperthermia (greater than 38.0°C) be avoided because it introduces potential associated risks |
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| Maintaining normal temperature immediately after birth in late preterm and term infants:
NLS 5100 (draft 2/2022) «https://costr.ilcor.org/document/maintaining-normal-temperature-immediately-after-birth-in-late-preterm-and-term-infants-nls-5100»4 |
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| Napanuoran sulkeminen | Delayed cord clamping in preterm infants requiring resuscitation (NRP 787) 3/2021 «https://costr.ilcor.org/document/cord-management-at-birth-for-preterm-infants-nls-787-systematic-review»5 |
In infants born at less than 34+0 weeks' gestational age who do not require immediate resuscitation after birth, we suggest deferring clamping the cord for at least 30 seconds |
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| In infants born at 28+0 to 33+6 weeks' gestational age who do not require immediate resuscitation after birth, we suggest intact-cord milking as a reasonable alternative to deferring cord-clamping |
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| We suggest against intact cord milking for infants born at less than 28+0 weeks' gestational age |
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| In infants born at less than 34+0 weeks' gestational age who require immediate resuscitation, there is insufficient evidence to make a recommendation with respect to cord management. | |||
| Cord Management at Birth for Term and Late Preterm infants (NLS#1551) Systematic Review
3/2021 «https://costr.ilcor.org/document/cord-management-at-birth-for-term-and-late-preterm-infants-nls-1551-systematic-review»6 |
For term and late preterm infants born at ≥34 weeks' gestation who are vigorous or deemed not to require immediate resuscitation at birth, we suggest later (delayed) clamping of the cord at ≥ 60 seconds |
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| Stimulaatio | Tactile Stimulation for Resuscitation Immediately After Birth (NLS #5140) Task Force
Systematic Review 1/2022. «Guinsburg R et al. Tactile Stimulation in Newborn...»2 «https://costr.ilcor.org/document/tactile-stimulation-for-resuscitation-immediately-after-birth-nls-5140-task-force-systematic-review»7 |
We suggest it is reasonable to apply tactile stimulation in addition to routine handling with measures to maintain temperature in newborn infants with absent, intermittent, or shallow respirations during resuscitation immediately after birth Tactile stimulation should not delay the initiation of positive pressure ventilation for newborns who continue to have absent, intermittent, or shallow respirations after birth. |
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| Ilmatie | Suctioning clear amniotic fluid at birth: NLS 5120 2/2022 draft (Previous 596) «https://costr.ilcor.org/document/suctioning-clear-amniotic-fluid-at-birth-nls-5120-previous-596»8 «https://costr.ilcor.org/document/suctioning-clear-amniotic-fluid-during-neonatal-resuscitation-in-the-delivery-room-nls-596-scoping-review»9 |
Suctioning of clear amniotic fluid from the nose and mouth should not be used as a routine step for newborn infants at birth. Airway positioning and suctioning should be considered if airway obstruction is suspected |
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| Tracheal suctioning of meconium at birth for non-vigorous infants: a systematic review
and meta-analysis (NLS #865): Systematic Review 4/2021 «Trevisanuto D, Strand ML, Kawakami MD ym. Tracheal...»3 «https://costr.ilcor.org/document/tracheal-suctioning-of-meconium-at-birth-for-non-vigorous-infants-a-systematic-review-and-meta-analysis-nls-865»10 |
For nonvigorous newborn infants delivered through meconium-stained amniotic fluid, we suggest against routine immediate direct laryngoscopy with or without tracheal suctioning compared with immediate resuscitation without direct laryngoscopy. Meconium-stained amniotic fluid remains a significant risk factor for receiving advanced resuscitation in the delivery room. Rarely, an infant may require intubation and tracheal suctioning to relieve airway obstruction. |
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| Supraglottic Airways for Neonatal Resuscitation NLS 618/#5340 2/2022 «https://costr.ilcor.org/document/supraglottic-airways-for-neonatal-resuscitation-nls-618»11 |
Where resources and training permit, we suggest that a supraglottic airway may be used in place of a face mask for newborn infants 34 0/7 weeks' or more gestation receiving intermittent positive pressure ventilation during resuscitation immediately after birth. |
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| Vasteen arviointi | Heart rate monitoring during neonatal resuscitation (NRP 898/2015, EVUp 2020 ) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
Treatment Recommendation In babies requiring resuscitation we suggest using ECG over oximetry and auscultation to measure heart rate faster and more accurately |
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| Delivery room heart rate monitoring to improve outcomes: (NLS #5201) draft 2/22 «https://costr.ilcor.org/document/cord-management-at-birth-for-term-and-late-preterm-infants-nls-1551-systematic-review»6 |
The use of ECG for heart rate assessment of a newly born infant requiring resuscitation in the delivery room is reasonable |
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| Where ECG is not available, auscultation with pulse oximetry is a reasonable alternative for heart rate assessment, but the limitations of these modalities should be kept in mind |
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| Respiratory Function Monitoring for Neonatal Resuscitation (NRP 806 2/2022 draft) «https://costr.ilcor.org/document/respiratory-function-monitoring-for-neonatal-resuscitation-nls-806»12 |
There is insufficient evidence to make a recommendation for or against the use of a respiratory function monitor in newborn infants receiving respiratory support at birth |
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| Ventilaatio ja lisähappi | Sustained Inflation at Birth (NLS # 809) Systematic Review 4/2021 «Kapadia VS, Urlesberger B, Soraisham A ym. Sustain...»4 «https://costr.ilcor.org/document/sustained-inflation-at-birth-nls-809-systematic-review»13 |
For preterm newborn infants who receive positive pressure ventilation due to bradycardia or ineffective respirations at birth, we suggest against the routine use of initial sustained inflation(s) greater than 5 seconds. A sustained inflation may be considered in research settings. For term or late preterm infants who receive positive pressure ventilation due to bradycardia or ineffective respirations at birth, it is not possible to recommend any specific duration for initial inflations due to the very low confidence in the estimates of effect. |
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| Continuous Positive Airway Pressure (CPAP) versus no CPAP For Term Respiratory Distress
in Delivery Room (NLS #5312) 1/2022 «https://costr.ilcor.org/document/continuous-positive-airway-pressure-cpap-versus-no-cpap-for-term-respiratory-distress-in-delivery-room-nls-5312»14 |
For spontaneously breathing late preterm and term newborn infants in the delivery room with respiratory distress, there is insufficient evidence to suggest for or against routine use of CPAP compared with no CPAP. | ||
| Outcomes for positive end-expiratory pressure (PEEP) versus no PEEP in the delivery
room (NRP 897, EVUp 2020) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
We suggest using PEEP for the initial ventilation of premature newborn infants during
delivery room resuscitation We cannot make any recommendation for term infants because of insufficient data. |
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| Continuous positive airway pressure (CPAP) and intermittent positive-pressure ventilation
(IPPV) (NRP 590, EvUp 2020) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
For spontaneously breathing preterm newborn infants with respiratory distress requiring respiratory support in the delivery room, we suggest initial use of CPAP rather than intubation and intermittent PPV). |
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| Devices for administering Positive Pressure Ventilation (PPV) at birth: (NLS#870)
Scoping Rev 1/2021 «Trevisanuto D, Roehr CC, Davis PG ym. Devices for ...»5 «https://costr.ilcor.org/document/devices-for-administering-positive-pressure-ventilation-ppv-at-birth-nls-870-systematic-review»15 |
Where resources permit, we suggest the use of a T-piece resuscitator over the use of a self-inflating bag either with or without a PEEP valve However, a self-inflating bag should be available as a backup for the T-piece resuscitator in the event of a gas supply failure (technical remark) |
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| Initial Oxygen Concentration for Preterm Neonatal Resuscitation: (NLS 864) Systematic
Review 1/2019 4/2021 «https://costr.ilcor.org/document/initial-oxygen-concentration-for-preterm-neonatal-resuscitation»16 |
For preterm newborn infants (less than 35 weeks' gestation) who receive respiratory
support at birth, we suggest starting with a lower oxygen concentration (21% to 30%)
rather than higher initial oxygen concentration (60% to 100%). We suggest the range of 21% to 30% oxygen because all trials used this for the low oxygen concentration group. |
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| Subsequent titration of oxygen concentration using pulse oximetry is advised. |
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| Initial Oxygen Concentration for Term Neonatal Resuscitation (NLS 1554): Systematic
Review 1/2019 4/2022 «https://costr.ilcor.org/document/initial-oxygen-concentration-for-term-neonatal-resuscitation»17 |
For newborn infants at 35 weeks' or greater gestation receiving respiratory support at birth, we suggest starting with 21% oxygen (air). |
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| We recommend against starting with 100% oxygen |
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| Paineluelvytys | Chest compression ratio (NRP 895, EvUp 2020 ) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
We suggest continued use of a 3:1 compression-to-ventilation ratio for neonatal CPR |
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| 2-Thumb versus 2-finger techniques for chest compression (NRP 605, EvUp 2020) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
We suggest that chest compressions in the newborn infant should be delivered by the 2-thumb, handsencircling- the-chest method as the preferred option and over the lower third of sternum. |
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| Lääkkeet ja nesteet | Dose, route and interval of epinephrine (adrenaline) for neonatal resuscitation (NLS
#593): Systematic Review 2/2020 4/2021 «https://costr.ilcor.org/document/dose-route-and-interval-of-epinephrine-adrenaline-for-neonatal-resuscitation-nls-593-systematic-review»18 |
If the heart rate has not increased to 60/min or greater after optimizing ventilation and chest compressions, we suggest the administration of intravascular epinephrine (adrenaline) (0.01–0.03 mg/kg) |
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| If intravascular access is not yet available, we suggest administering endotracheal epinephrine (adrenaline) at a larger dose (0.05–0.1 mg/kg) than the dose used for IV administration |
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| The administration of endotracheal epinephrine (adrenaline) should not delay attempts to establish vascular access . |
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| If the response to endotracheal epinephrine (adrenaline) is inadequate, we suggest that an intravascular dose be given as soon as vascular access is obtained, regardless of the interval after any initial endotracheal dose |
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| We suggest the administration of further doses of epinephrine (adrenaline) every 3 to 5 minutes, preferably intravascularly, if the heart rate remains less than 60/min. |
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| Intravenous vs. Intraosseous administration of drugs during cardiac arrest (NLS 616):
Systematic Review «Granfeldt A, Avis SR, Lind PC ym. Intravenous vs. ...»6 «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
We suggest umbilical venous catheterization as the primary method of vascular access during newborn infant resuscitation in the delivery room. If umbilical venous access is not feasible, the intraosseous route is a reasonable alternative for vascular access during newborn resuscitation |
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| Outside the delivery room setting, we suggest that either umbilical venous access or the intraosseous route may be used to administer fluids and medications during newborn resuscitation. The actual route used may depend on local availability of equipment, training and experience. |
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| Volume infusion during neonatal resuscitation (NLS 598: EvUp 2020) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
Early volume replacement with crystalloid or red cells is indicated for newborn infants with blood loss who are not responding to resuscitation. There is insufficient evidence to support the routine use of volume administration in the newborn infant with no blood loss who is refractory to ventilation, chest compressions, and epinephrine. Because blood loss may be occult, a trial of volume administration may be considered in newborn infants who do not respond to resuscitation. | ||
| Sodium bicarbonate during neonatal resuscitation (NLS 606: EvUp 2020) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
Sodium bicarbonate is discouraged during brief CPR but may be useful during prolonged arrests after adequate ventilation is established and there is no response to other therapies. | ||
| Tuloksettoman elvytyksen lopettaminen | Impact of duration of intensive resuscitation (NLS #895): Systematic Review 2/2020 4/2021 «https://costr.ilcor.org/document/impact-of-duration-of-intensive-resuscitation-nls-896-systematic-review»19 |
Failure to achieve return of spontaneous circulation in newborn infants after 10-20 minutes of intensive resuscitation is associated with a high risk of mortality and a high risk of moderate to severe neuroimpairment among survivors. However, there is no evidence that any specific duration of resuscitation consistently predicts mortality or moderate to severe neurodevelopmental impairment. If a newborn infant requires ongoing cardiopulmonary resuscitation (CPR) after birth despite completing all the recommended steps of resuscitation and excluding reversible causes, we suggest initiating discussion of discontinuing resuscitative efforts with the clinical team and family. A reasonable timeframe for this change in goals of care is around 20 minutes after birth. |
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| Hypotermisen potilaan hoito | Warming of hypothermic newborns (NRP 858, EvUp 2020) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
The confidence in effect estimates is so low that a recommendation for either rapid rewarming (0.5°C/h or greater) or slow rewarming (0.5°C/h or less) of unintentionally hypothermic newborn infants (temperature less than 36°C) at hospital admission would be speculative. | |
| Postresuscitation glucose management (NLS 607: EvUp 2020) «https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000895&file=Supplement+Appendix+C+%283%29.pdf»2 |
Intravenous glucose infusion should be considered as soon as practical after resuscitation, with the goal of avoiding hypoglycemia. | ||
| Family Presence During Resuscitation CoSTR (NLS 1590; PLS 384) ESR 3/2020 4/2021 «https://costr.ilcor.org/document/systematic-review-nls-family-presence-during-resus-neonatal-costr»20 |
We suggest it is reasonable for mothers/fathers/partners to be present during the resuscitation of neonates where circumstances, facilities and parental inclination allow. |
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