1. Session Title: NRP Current Issues Seminar
Session Number: C0006
Myra H. Wyckoff, MD, FAAP
UT Southwestern Medical Center at Dallas

2. Update on the International Liaison Committee on Resuscitation (ILCOR) The 2015 Scientific Review is almost here!

3. 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.

4. Achieving Consensus on Resuscitation Science
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
Australian
Resuscitation
Council

5. ILCOR 2010 Neonatal Working Group

6. 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:

7. NRP Guidelines are set by the AAP NRP Steering Committee

8. 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
Circulatory Support
Compression/Ventilation 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
Ventilation Strategies
CPAP and IPPV
LMA
Comparing IPPV devices
Ventilation parameters for neonates
Postresuscitation Management
Hypothermia (induced)
Maternal fever
Supplemental glucose
Monitoring During and After Intubation
Bradycardia and CO2 monitoring
CO2 detection
Ventilation volume monitoring
Withholding or Stopping Resuscitation Efforts
Duration of CPR with asystole and outcome
Futile resuscitation rules
Teaching Resuscitation
High fidelity training
Impact of debriefing on team performance

9. Initial Assessment and Intervention
CO2 detector, pulse oximetry
O2 use during CPR
O2 saturation targets for preterms
Meconium suctioning of the non-
vigorous infants
Umbilical Cord Clamping for non-
Prenatal prediction of respiratory
compromise
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
Ventilation Strategies
CPAP and IPPV
LMA
Comparing IPPV devices
PEEP vs no PEEP
Sustained Inflation
Postresuscitation Management
Hypothermia (induced)
Maternal fever
Supplemental glucose
Monitoring During and After Intubation
Bradycardia and CO2 monitoring
CO2 detection
Ventilation volume monitoring
Withholding or Stopping Resuscitation Efforts
Apgar score of 0 at 10 minutes
Futile resuscitation
Teaching Resuscitation
Frequency of training
Impact of debriefing on team performance

10. 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 non-vigorous 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?
I have no disclosures to make

11. 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?

12. 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 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?
77 F

13. 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?

14. 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?

15. 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

16. 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?

17. Great News!
There is lots of new science to review and incorporate into the new ILCOR guidelines!

18. Ackowledgments
Thanks to the AAP for several of the photos used for illustration