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INTRODUCTION

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It is widely accepted that 10% of all newborns require some assistance to begin and maintain normal breathing and that 1% require aggressive resuscitation. Thus, using the national birth rate data, annually 400,000 newborns need some help during the perinatal period, 40,000 per year require expert assistance to reverse profound cardiorespiratory depression.1 Of these, approximately 1200 per year will have severe hypoxic ischemic encephalopathy (HIE). According to the World Health Organization, more than 722,000 children died from birth asphyxia and birth trauma worldwide in 2004. An estimated 50% to 75% of infants with severe HIE will die, with 55% of these deaths occurring in the first month.

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You need only to relate these statistics to your own practice to appreciate the frequency with which you may encounter an infant in need of neonatal resuscitation and at risk for long-term neurodevelopmental sequelae. Unfortunately, despite best efforts by care providers, this goal is often challenged by the expected, or, even more challenging, unexpected delivery of a neonate who requires urgent medical attention for a disorder(s) threatening his/her life. Obstetrical providers are, by training and experience, more skilled in adult than neonatal emergency care. Consequently, without standards in place that direct personnel, training, and equipment, an obstetrical practitioner may find himself/herself ill prepared to effectively respond to a neonatal emergency. The objective of this chapter is to offer an overview of the pathophysiology, organization, and provision of emergency medical care to the newly born patient for the obstetrical primary care provider.

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This chapter is not meant to replace the information found in references such as the Textbook of Neonatal Resuscitation. Instead, the reader will be guided through an approach of creating an environment conducive to facilitating optimal neonatal emergency care. This will include a brief discussion of the organization of neonatal resuscitation teams and equipment, and a review of resuscitation guidelines. Readers interested in more detail will find additional resources in the selected list of suggested readings. All obstetrical clinicians will find completing Neonatal Resuscitation Program (NRP) certification useful and are encouraged to do so.

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ORGANIZATION

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Identification of Peripartum Risk Factors

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Anticipating the specific clinical circumstances leading to the need for neonatal resuscitation in the delivery room or postnatal Neonatal intensive care unit (NICU) care is very helpful. Not enough can be said for the value of time to prepare for a sick newborn. In addition, while the basics of resuscitation do not vary from one patient to the next, certain clinical situations will require the resuscitation team to be prepared to provide specific medical care beyond the usual. For example, the needs of an uncomplicated 28-week premature infant delivered for worsening maternal preeclampsia will be quite different from a term infant with chronic opioid exposure, or a 36-week-old child with nonimmune hydrops fetalis. Table 24-1 shows many of the more common ante- and intrapartum conditions ...

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