Georg Schmolzer

By Georg M Schmölzer, Anne Solevåg, Erica McGinn, Megan O’Reilly and Po-Yin Cheung

Chest compression (CC) is an infrequent event (0.08%) in newborns delivered at near-term and term gestation, and occurs at a higher frequency (10%) in preterm deliveries. In addition, outcome studies of deliveries requiring resuscitation or chest compression have reported high rates of mortality and neurodevelopmental impairment in surviving children. A respiratory function monitor (RFM) can help guide a resuscitator during cardiopulmonary resuscitation (CPR) in a neonate and help assess the quality and efficacy of chest compression. Utilizing a non-invasive respiratory function monitor during chest compression may decrease high mortality rates in addition to having many distinct advantages, which will benefit both the newborn and the resuscitators. There are several different ways that a respiratory function monitor can assist a resuscitator during chest compression; these include confirming and ensuring adequate lung ventilation, analyzing the efficacy and quality of chest compression and exhaled CO2 monitoring.

Part of the book: Respiratory Management of Newborns

By Gianluca Lista, Georg M. Schmölzer and Ilia Bresesti

The proper management of respiratory distress syndrome in the delivery room is a crucial step in the transition to extrauterine life, especially for preterm infants. In fact, it has been widely established that the optimization of the cardiovascular and the respiratory changes, which normally happen as soon as a term healthy baby is delivered, can have long-term effects. For this reason, every clinician approaching the delivery room should be aware of the consequences an inappropriate management could lead to and should know how to perform a proper resuscitation, using, where available, the most recent techniques. Regardless of the level of care provided by the hospital, there are some key interventions, which can be applied easily in every setting and are of crucial importance. In this chapter, we aim to provide a comprehensive overview of the most relevant measures to manage respiratory distress syndrome from the delivery room, starting from an explanation of the disease and moving toward the most recent evidence, from the basic concepts to the most advanced techniques to monitor fetal-neonatal transition.

Part of the book: Pregnancy and Birth Outcomes

By Francesca Viaroli and Georg M. Schmölzer

The majority of newborn infants make the transition from fetal-to-neonatal live without help. However, around 20% of newborn infants fail to initiate breathing at birth. In these cases, the clinical team has to provide respiratory support, which remains the cornerstone of neonatal resuscitation. This chapter will discuss respiratory support during neonatal resuscitation in both term and preterm infants. The chapter will discuss the respiratory fetal-to-neonatal transition, use of oxygen, mask ventilation and their pitfalls, the application of sustained inflation, positive end expiratory pressure, continuous positive airway pressures, and whether extremely low birth weight infants should be intubated immediately after birth or supported noninvasively.

Part of the book: Special Topics in Resuscitation

By Megan O’Reilly, Po-Yin Cheung, Tze-Fun Lee and Georg M. Schmölzer

Two to three million newborn infants worldwide need extensive cardiopulmonary resuscitation (CPR), and approximately one million of these infants die annually worldwide. Therefore, resuscitation techniques require further refinement to provide better outcomes. To investigate the effectiveness of various interventions and to understand the pathophysiology and pharmacology of neonatal CPR, it is important to have animal models that reliably reproduce features observed in neonates who require resuscitation. Herein, we describe an experimental animal model in newborn piglets that simulates neonatal asphyxia and enables us to examine resuscitation interventions, reoxygenation, and recovery processes. The newborn piglet has several advantages including similar development to a human fetus at 36–38 week’s gestation, and comparable body systems and body size, allowing for surgical instrumentation, monitoring, and collection of biological samples. Furthermore, using this model of neonatal asphyxia, we are also able to describe an increasingly important clinical situation in the laboratory setting—pulseless electrical activity (PEA). Since the integration of electrocardiogram into the neonatal resuscitation guidelines, there has been an increased awareness of PEA in newborn infants. The animal model we describe can therefore serve as a valuable tool to bridge the knowledge gap and improve the outcome of asphyxiated newborns in the delivery room.

Part of the book: Animal Models in Medicine and Biology