This document provides guidelines for delivery room stabilization of newborns based on a European consensus statement from 2019. It recommends delaying umbilical cord clamping for at least 60 seconds, maintaining temperatures between 36.5-37.5°C for preterm infants, using CPAP of at least 6 cm H2O for spontaneously breathing babies, and gentle PPV for apneic or bradycardic infants. It also provides guidance on oxygen use and targets, and reserves intubation for babies not responding to other measures while recommending surfactant for those requiring intubation.

1. EUROPEAN CONSENSUS STATEMENT ON RDS
MANAGEMENT (2019)
Tageldin Aly
DELIVERY ROOM STABILIZATION
Neonatal consultant

3. DELIVERY ROOM STABILIZATION
:
1. Delay clamping the umbilical cord for at least
60 s to promote placento-fetal transfusion.
(A1)
2. Temperature management Plastic bags or
occlusive wrapping under radiant warmers should
be used during stabilization in the delivery suite for
babies < 28 weeks’ gestation to reduce the risk of
hypothermia. (A1)

4. confirms that DCC
is associated with less intraventricular hemorrhage (IVH) of any
grade, higher blood pressure and blood volume, less need for
transfusion after birth, and less necrotizing enterocolitis.
There was no evidence of decreased mortality or decreased incidence
of severe IVH.
The studies were judged to be very low quality (downgraded for
imprecision and very high risk of bias).
The only negative consequence appears to be a slightly increased level
of bilirubin, associated with more need for phototherapy.

5. Hypothermia is also associated with serious
morbidities, such as increased risk of IVH, RDS ,
hypoglycemia ,and LOS .
Because of this, admission temperature should be
recorded as a predictor of outcomes as well as a
quality indicator ,It is recommended that the
temperature of newly born non asphyxiated
infants be maintained between 36.5°C and 37.5°C
after birth through admission and stabilization
(Class I, LOE C-LD)

6. DELIVERY ROOM STABILIZATION
3. In spontaneously breathing babies, stabilise with
CPAP of at least 6 cm H2O via mask or nasal
B))prongs
4. Do not use Sustained Inflation as there is no
long-term benefit (B1).
5. Gentle positive pressure lung inflations (PPV)
with 20–25 cm H2O peak inspiratory pressure
(PIP) should be used for persistently apnoeic or
bradycardic infants.

7. a benefit of sustained inflation for reducing need for
mechanical ventilation (very low quality of evidence,
downgraded for variability of interventions). However, no
benefit was found for reduction of mortality,BPD , or air
leak.
One cohort study136 suggested that the need for intubation
was less after sustained inflation.
There are insufficient data regarding short and long-term
safety and the most appropriate duration and pressure of
inflation to support routine application of sustained
inflation of greater than 5 seconds’ duration to the
transitioning newborn (Class IIb, LOE B-R).
Further studies using carefully designed protocols are needed

8. PPV avoid
volutraumaExcessive TV
Excessive pressure barotrauma

9. DELIVERY ROOM STABILIZATION
6. Oxygen for resuscitation should be controlled
using a blender.
• Use an initial FiO2 of
– 0.30 for babies < 28 weeks’ gestation
– 0.21–0.30 for those 28–31 weeks,
– 0.21 for 32 weeks’ gestation and above.
• FiO2 adjustments up or down should be
guided by pulse oximetry (B2).

10. Use of Pulse Oximetry
oximetry be used when resuscitation can be
anticipated, when PPV is administered, when
central cyanosis persists beyond the first 5 to
10 minutes of life, or when supplementary
oxygen is administered.

11. DELIVERY ROOM STABILIZATION
•7. Targeted O2 sat. For infants < 32 weeks’
gestation, SpO2 of 80% or more (and heart rate >
100/min) should be achieved within5 min. ( c)
8. Intubation should be reserved for babies not
responding to positive pressure ventilation via
face mask or nasal prongs. (A1)
• 9. Babies who require intubation for
B))stabilisation should be given surfactant

12. Early intubation and surfactant required for
babies who demonstrate Early sign of sever
RDS such as chest retraction and high oxygen
requirement