2010 Guidelines for Neonatal Resuscitation: Does the Algorithm Require a Clarification?

Daniele Trevisanuto, Claudio Martano, Luigi Giannini, Fabrizio Ciralli, Sandra Di Fabio, Camilla Gizzi, Lorenzo Quartulli, Flaminia Torielli and Paolo Ernesto Villani Pediatrics 2011;128;e471 DOI: 10.1542/peds.2011-1909A

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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2011 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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LETTERS TO THE EDITOR

2010 Guidelines for Neonatal Resuscitation: Does the Algorithm Require a Clarication?
We read with interest the Kattwinkel et al1 article on the 2010 Guidelines for Neonatal Resuscitation. As the Neonatal Resuscitation Study Group of the Italian Society of Neonatology, we are currently in the process of updating the national neonatal resuscitation programs according to the 2010 Guidelines for Neonatal Resuscitation. While reviewing the above-mentioned article, an issue came to our attention that we believe deserves clarication. In the gure, at the bottom of the neonatal resuscitation algorithm, in case of a negative answer (no) to the question HR below 60? the arrow sends the reader to the box Consider intubation, Chest compressions, Coordinate with PPV. To our knowledge, when the heart rate is above 60 bpm, chest compressions are never indicated. Furthermore, this part of the algorithm is different from that proposed by Perlman et al2 and could lead to misinterpretation. Therefore, we suggest that this part of the algorithm be changed by shifting the arrow to the previous box of the gure (HR below 60? No).
Daniele Trevisanuto, MD Pediatric Department Medical School University of Padua Azienda Ospedaliera Padova 35128 Padua, Italy Claudio Martano Neonatal Intensive Care Unit Pediatric Department Medical School University of Turin, Azienda Ospedaliera

OIRM-S.Anna 10126 Torino, Italy Luigi Giannini, MD Pediatric Department Medical School University La Sapienza Rome Azienda ospedaliera Policlinico Umberto I 00161 Rome, Italy Fabrizio Ciralli, MD Neonatal Intensive Care Unit Department of Mother and Infant Science Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico University of Milan 20122 Milan, Italy Sandra Di Fabio, MD Neonatal Intensive Care Unit Department of Mother and Infant Scienze San Salvatore Hospital ASL 1 67100 LAquila, Italy Camilla Gizzi, MD Neonatal Intensive Care Unit S. Giovanni Calibita Fatebenefratelli Hospital Isola Tiberina 00186 Rome, Italy Lorenzo Quartulli, MD Neonatology Unit A. Perrino HospitalASL 72100 Brindisi, Italy Flaminia Torielli, MD Neonatology Unit San Martino University Hospital 16100 Genova, Italy Paolo Ernesto Villani, MD Emergency Department Neonatology and Pediatric Unit Vaio Hospital, AUSL 43036 Parma, Italy

2. Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, et al; Neonatal Resuscitation Chapter Collaborators. Neonatal resuscitation: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Pediatrics. 2010;126:e1319 e1344
doi:10.1542/peds.2011-1909A

In Reply
We thank the Italian Resuscitation Committee for comments about the Consensus on CPR and ECC Science and Treatment Recommendations (CoSTR) neonatal algorithm versus the 2010 neonatal guidelines algorithm. The expanded version in the guidelines document is, indeed, in error, and we appreciate your bringing this to our attention and prompting us to make the correction. The algorithm was changed from the last guidelines and NRP textbook edition because of the recognition that many resuscitators were initiating chest compressions before ensuring adequate ventilation; hence, we added the Take ventilation corrective steps statement. However, our Italian colleagues are correct that chest compressions are not indicated if the heart rate is 60 beats per minute. A revised resuscitation owchart appears below, in the 6th edition of the NRP textbook, and in an erratum submitted for the guidelines article.
John Kattwinkel, MD Editor, NRP Textbook Jeffrey Perlman, MD, Co-Chair ILCOR Neonatal Task Force
doi:10.1542/peds.2011-1909B

REFERENCES
1. Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, et al; American Heart Association. Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics. 2010;126: e1400 e1413

PEDIATRICS Volume 128, Number 2, August 2011

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e471

2010 Guidelines for Neonatal Resuscitation: Does the Algorithm Require a Clarification? Daniele Trevisanuto, Claudio Martano, Luigi Giannini, Fabrizio Ciralli, Sandra Di Fabio, Camilla Gizzi, Lorenzo Quartulli, Flaminia Torielli and Paolo Ernesto Villani Pediatrics 2011;128;e471 DOI: 10.1542/peds.2011-1909A
Updated Information & Services References including high resolution figures, can be found at: http://pediatrics.aappublications.org/content/128/2/e471.1.full .html This article cites 2 articles, 2 of which can be accessed free at: http://pediatrics.aappublications.org/content/128/2/e471.1.full .html#ref-list-1 This article, along with others on similar topics, appears in the following collection(s): Premature & Newborn http://pediatrics.aappublications.org/cgi/collection/premature _and_newborn Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://pediatrics.aappublications.org/site/misc/Permissions.xht ml Information about ordering reprints can be found online: http://pediatrics.aappublications.org/site/misc/reprints.xhtml

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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2011 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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