Ten minutes to save a baby: a narrative review of newborn assessment during first minutes of life and relationship to outcomes

Background and Objectives: The first 10 minutes of life is the most important for a newborn infant. For the 1% of infants that require extensive resuscitation measures, rapid evaluation of vital signs, including oxygen saturation and heart rate is vital. How a clinician achieves prompt and accurate assessment of the sick newborn infant within a few minutes remains one of the most important knowledge and practice gaps in modern newborn medicine. Over the last two decades, international newborn resuscitation practice has changed considerably. The most profound development is the focus on oxygenation within the first 10 minutes of life, with a global secular shift to using "lower oxygen strategies". However, there is now emerging information of adverse consequences from low oxygenation during the first 5 minutes of life, especially in very preterm infants (<29 weeks' gestation) who are already at highest risk of death. We aim to review delivery room practice aimed to provide best and most accurate assessment of the cardiorespiratory status of sick newborn infants. Methods: We performed a broad search of PubMed, MEDLINE, Google Scholar and scrutinized the reference lists of relevant English articles published before November 4th 2021, including systematic reviews, meta-analyses, randomized controlled trials, retrospective studies and previous narrative reviews. Key Content and Findings: This review outlines the clinical and biometric methods of assessing the newborn in the delivery room. We explore the strengths and weakness of each modality, and highlight that the resuscitation team must synthesize clinical and biometric information to guide their care. Conclusions: Clinicians must balance information gained from technology (e.g., pulse oximetry) with clinical judgement of the infant's progress. Significantly more knowledge is needed to inform on the best assessment methods to guide resuscitation of the sick newborn infant. Failure to do so will prevent advances in research and stagnate efforts to improve outcomes for all sick newborn infants around the world.