Perinatal Transition and Newborn Resuscitation

The transition from fetal to neonatal life is a complex process. Individuals who care for newborns must monitor the progress of this transition and be prepared to intervene when necessary. Key elements necessary for a successful transition to extrauterine life involve changes in thermoregulation, respiration, and circulation. Preparation prior to delivery helps ensure timely and effective newborn resuscitation. In most cases, it is possible to use perinatal risk factors to predict which newborns will need resuscitation. Delayed umbilical cord clamping following delivery may have a significant impact on newborn outcomes. Ventilation of a newborn’s lungs at birth is the most important step in newborn resuscitation. Ventilation is typically provided using a face mask and a positive pressure ventilation (PPV) device. Newborns who do not respond to mask ventilation may need endotracheal intubation or placement of a laryngeal mask airway. The laryngeal mask airway is an easy-to-use alternative to intubation in newborns at ≥34 weeks gestation and > 2000g. Chest compressions and medications are used only in newborns who do not respond to PPV that adequately ventilates the lungs. Devices such as carbon dioxide detectors, pulse oximetry, electrocardiography, and respiratory function monitors can be helpful during resuscitation. Post-resuscitation care is critical to ensure optimal outcomes after newborn resuscitation.