INTRODUCTION

The successful transition from intrauterine to extrauterine life is dependent upon significant physiologic changes that occur at birth. In almost all infants (90 percent), these changes are successfully completed at delivery without requiring any special assistance. However, about 10 percent of infants will need some intervention, and 1 percent will require extensive resuscitative measures at birth [1].

The indications and principles of neonatal resuscitation will be reviewed here. The physiological changes that occur in the transition from intrauterine to extrauterine life are discussed separately. (See "Physiologic transition from intrauterine to extrauterine life".)

ANTICIPATION OF RESUSCITATION NEED

Being prepared is the first and most important step in delivering effective neonatal resuscitation [1]. Neonates requiring resuscitation are inevitably born in locations where resuscitation is uncommon because most newborns are healthy and do not require additional special assistance. In these settings, the need for resuscitation is not anticipated in the most infants who require resuscitation [2]. As a result, at every birthing location, personnel who are adequately trained in neonatal resuscitation should be readily available to perform neonatal resuscitation whether or not problems are anticipated.

In all instances, at least one healthcare provider is assigned primary responsibility for the newborn infant. This person should have the necessary skills to evaluate the infant, and, if required, to initiate resuscitation procedures such as positive pressure ventilation and chest compressions. In addition, either this person or another who is immediately available should have the requisite knowledge and skills to carry out a complete neonatal resuscitation including endotracheal intubation and administration of medications.

Equipment needed for resuscitation should be available at every delivery area (table 1), and routinely checked to ensure the equipment is functioning properly [3].