Session Title: NRP Current Issues Seminar
Session Number: C0006
Myra H. Wyckoff, MD, FAAP
UT Southwestern Medical Center at Dallas
Update on the International
Liaison Committee on
Resuscitation (ILCOR)
The 2015 Scientific Review is almost here!
Faculty Disclosure Information
In the past 12 months, I have no relevant financial relationships with the
manufacturer(s) of any commercial product(s) and/or provider(s) of
commercial services discussed in this CME activity.
I do not intend to discuss an unapproved/investigative use of a commercial
product/device in my presentation.
Achieving Consensus on
Resuscitation Science
Australian
Resuscitation
Council
 Since 2000, the AAP with the American
Heart Association, participates with the
International Liaison Committee on
Resuscitation (ILCOR) for a complete
review of resuscitation science every 5
years.
 32 new questions being reviewed for
2015
ILCOR 2010 Neonatal Working Group
Guidelines for
Neonatal Resuscitation
 Guidelines available online
October 19, 2015
 Printed Guidelines
supplement will be published
in Circulation, Resuscitation
and likely Pediatrics
 Will be able to download at:
www.heart.org/cpr
NRP Guidelines are set by the AAP
NRP Steering Committee
Initial Assessment and Intervention
CO2 detector, pulse oximetry
O2 use during resuscitation
O2 saturation targets
Meconium stained amniotic fluid
Umbilical Cord Clamping
Prenatal prediction of respiratory
compromise
Supportive Therapy
Warming Adjuncts
Ventilation Strategies
CPAP and IPPV
LMA
Comparing IPPV devices
Ventilation parameters for neonates
Monitoring During and After Intubation
Bradycardia and CO2 monitoring
CO2 detection
Ventilation volume monitoring
Teaching Resuscitation
High fidelity training
Impact of debriefing on team performance
Circulatory Support
Compression/Ventilation ratio
2 Thumb vs 2 Finger CPR
Epinephrine dosing
IO vs IV
IV vs ETT drugs
Naloxone
Sodium Bicarbonate
Volume Resuscitation
Postresuscitation Management
Hypothermia (induced)
Maternal fever
Supplemental glucose
Withholding or Stopping Resuscitation Efforts
Duration of CPR with asystole and outcome
Futile resuscitation rules
Initial Assessment and Intervention
CO2 detector, pulse oximetry
O2 use during CPR
O2 saturation targets for preterms
Meconium suctioning of the nonvigorous infants
Umbilical Cord Clamping for nonvigorous infants
Prenatal prediction of respiratory
compromise
Ventilation Strategies
CPAP and IPPV
LMA
Comparing IPPV devices
PEEP vs no PEEP
Sustained Inflation
Monitoring During and After Intubation
Bradycardia and CO2 monitoring
CO2 detection
Ventilation volume monitoring
Teaching Resuscitation
Frequency of training
Impact of debriefing on team performance
Circulatory Support
Compression/Vent ratios
2 Thumb vs 2 Finger CPR
Epinephrine dosing
IO vs IV
IV vs ETT drugs
Naloxone
Sodium Bicarbonate
Volume Resuscitation
Supportive Therapy
Warming Adjuncts
Impact of Maternal Temp
Impact of Hypothermia
Impact of Hyperthermia
Postresuscitation Management
Hypothermia (induced)
Maternal fever
Supplemental glucose
Withholding or Stopping Resuscitation Efforts
Apgar score of 0 at 10 minutes
Futile resuscitation
Hot Topics in Neonatal Resuscitation
 Should cord clamping be delayed for neonates
who are non-vigorous?
 How to best maintain euthermia of the neonate in
the delivery room?
 Does intubation and suction benefit the nonvigorous meconium stained neonate?
 How should oxygen be used for premature
neonates in the delivery room?
 How to deliver initial breaths to a premature
neonate in the delivery room?
Handling of the Cord
 In preterm neonates including those who require resuscitation
does delayed cord clamping versus immediate cord clamping
improve outcome?
 In very preterm infants does milking the cord versus immediate
clamping improve outcomes?
Temperature Management in the DR
 In non-asphyxiated babies at birth, does maintenance of
normothermia (Core temp>=36.5 degrees and <=37.5 degrees
centigrade) from delivery to admission, compared with
hypothermia (< 36ºC) or hyperthermic (> 37.5ºC), change
77 F
outcome.
 Among preterm neonates who are under radiant warmers in the
hospital, does increased room temperature, thermal mattress, or
another intervention, compared with plastic wraps alone, change
outcome?
Suctioning of the Non-vigorous Meconium
Stained Infant
 Does suctioning of the trachea improve outcomes (prevent
meconium aspiration syndrome, etc.) for non-vigorous
meconium stained infants?
Handling of the Cord
 In preterm neonates including those who require resuscitation
does delayed cord clamping versus immediate cord clamping
improve outcome?
 In very preterm infants does milking the cord versus immediate
clamping improve outcomes?
Delivery Room O2
 Among preterm newborns (< 37 wks GA) who receive PPV in the
delivery room, does low initial oxygen (21-30%) as opposed to
high initial high oxygen (80-100%) decrease mortality, BPD, ROP,
neurologic deficit, time to HR > 100 bpm
How to Deliver Initial Breaths to a
Preterm Infant in the DR
 In term/preterm newborn infants who do not establish
spontaneous respiration at birth, does the administration of one
or more pressure-limited sustained lung inflations lasting 15-30s
as compared to intermittent positive pressure ventilation with
short inspiratory times (< 1s) for 30-60s improve outcome?
Great News!
 There is lots of new science to review and
incorporate into the new ILCOR
guidelines!
Ackowledgments
 Thanks to the AAP for several of the
photos used for illustration