Overview
Transition and Immediate Resuscitation
Birth is a rapid physiologic handoff. Placental gas exchange stops, the lungs must clear fluid and fill with air, pulmonary vascular resistance should fall, pulmonary blood flow...
Birth is a rapid physiologic handoff. Placental gas exchange stops, the lungs must clear fluid and fill with air, pulmonary vascular resistance should fall, pulmonary blood flow should rise, and fetal shunts should begin to close. Failure at any point produces the same bedside priority: assess breathing and heart rate, support ventilation, and prevent heat loss. Before delivery, identify gestational age, fetal growth, maternal fever or infection, bleeding, diabetes, medications or substance exposure, abnormal fetal testing, congenital anomalies, and the appearance of the amniotic fluid. Prepare equipment and personnel according to the anticipated risk rather than waiting for deterioration. When the newborn does not require immediate resuscitation, defer cord clamping for at least 60 seconds. This applies to preterm infants younger than 37 weeks as well as term infants and improves early hematologic indices and iron status. If deferred clamping is not feasible, intact cord milking may be considered from 28 0/7 through 36 6/7 weeks; it should not be performed below 28 weeks. The initial sequence is deliberately simple: 1. Provide warmth, position the airway, dry, and stimulate. 2....