OBJECTIVE: The goal was to define reference ranges for pulse oxygen saturation (Spo₂) values in the first 10 minutes after birth for infants who received no medical intervention in the delivery room. METHODS: Infants were eligible if a member of the research team was available to record Spo₂ immediately after birth. Infants were excluded if they received supplemental oxygen or any type of assisted ventilation. Spo₂ was measured with a sensor applied to the right hand or wrist as soon as possible after birth; data were collected every 2 seconds. RESULTS: We studied 468 infants and recorded 61650 Spo₂ data points. The infants had a mean ± SD gestational age of 38 ± 4 weeks and birth weight of 2970 ± 918 g. For all 468 infants, the 3rd, 10th, 50th, 90th, and 97th percentile values at 1 minute were 29%, 39%, 66%, 87%, and 92%, respectively, those at 2 minutes were 34%, 46%, 73%, 91%, and 95%, and those at 5 minutes were 59%, 73%, 89%, 97%, and 98%. It took a median of 7.9 minutes (interquartile range: 5.0–10 minutes) to reach a Spo₂ value of >90%. Spo₂ values for preterm infants increased more slowly than those for term infants. We present percentile charts for all infants, term infants of ≥37 weeks, preterm infants of 32 to 36 weeks, and extremely preterm infants of <32 weeks. CONCLUSION: These data represent reference ranges for Spo₂ in the first 10 minutes after birth for preterm and term infants.

Aim: The aim was to compare resuscitators' estimates of tidal volume (V_T) and face mask leak with measured values during positive pressure ventilation (PPV) of newborn infants in the delivery room. Patients and methods: The authors measured inflating pressures and V_T delivered using a respiratory function monitor, and calculated face mask leak. After 60 s of PPV, resuscitators were asked to estimate V_T and face mask leak. These estimates were compared with measurements taken during the previous 30 s. Results: The authors studied 20 infants who received a mean (SD) of 21 (6) inflations during the 30 s. The median (IQR) expired tidal volume (V_Te) delivered was 8.7 ml/kg (5.3–11.3). V_Te varied widely during each resuscitation and between resuscitators. Five resuscitators could not estimate V_Te, one overestimated and 14 underestimated their median delivered V_Te. The median (IQR) face mask leak was 29% (16–63%). Leak also varied widely during each resuscitation and between resuscitators. One resuscitator could not estimate mask leak, four overestimated leak and 15 underestimated leak. Conclusion: During face mask ventilation in the delivery room, V_T and face mask leak were large and variable. The resuscitators were unable to accurately assess their face mask leak or delivered V_T.

Introduction Preterm infants with inadequate breathing receive positive pressure ventilation (PPV) by mask with variable success. The authors examined recordings of PPV given to preterm infants in the delivery room for prevalence of mask leak and airway obstruction. Methods and patients The authors reviewed recordings of infants at 75%. Results The authors analysed recordings of 56 preterm infants. Obstruction occurred in 14 (26%) recordings and leaks in 27 (51%). Both obstruction and mask leaks were seen in eight (14%) recordings, and neither was seen in 15 (27%). Obstruction occurred at a median (IQR) of 48 (24–60) s after the start of PPV. A median (range) of 22 (3–83) consecutive obstructed inflations were delivered. Face-mask leaks occurred from the first inflation in 19/27 (70%) and in the remaining eight at a median (IQR) of 30 (24–46) s after the start of PPV. A median (range) of 10 (3–117) consecutive inflations with a leak >75% were delivered. Conclusion Airway obstruction and face-mask leak are common during the first 2 min of PPV. An RFM enables detection of important airway obstruction and mask leak.

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.