What is included in initial resuscitation and stabilization of infants with hypoxic-ischemic encephalopathy (HIE)?

Updated: Jul 18, 2018
  • Author: Santina A Zanelli, MD; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Answer

Delivery room management follows standard Neonatal Resuscitation Program (NRP) guidelines. Close attention should be paid to appropriate oxygen delivery, perfusion status, avoidance of hypoglycemia and hyperglycemia, as well as avoidance of hyperthermia.

A lot of attention has been focused on resuscitation with room air versus 100% oxygen in the delivery room. Several clinical trials indicate that room air resuscitation for infants with perinatal asphyxia is as effective as resuscitation with 100% oxygen. In addition, infants resuscitated with room air have a lower level of circulating markers of oxidative stress. However, studies indicating that time to return to spontaneous circulation is equivalent with room air resuscitation are lacking. Based on this evidence, International Liaison Committee on Resuscitation (ILCOR) and NRP guidelines were updated and are now recommending the use of 21% oxygen for the initial resuscitation of term infants. If despite effective ventilation, the infant does not improve, higher concentrations of oxygen should be used and should be guided by the use of pulse oxymetry. [67, 68]


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