Delivery room management, especially in the first ‘golden' minute, is of the utmost importance. An exact and universal definition of when a baby is born is needed to obtain agreement on what is meant by the first minute of life. Education of young girls is a basic requirement to optimize the health of the mother and baby. Interventions in pregnancy should as far as possible be evidence based. Antenatal care, the selection of birth mode and antenatal steroid therapy when indicated also contribute to obtaining the best outcome. Delayed cord clamping is recommended for both preterm and term infants. However, more data are needed regarding the most immature infants. Routine suctioning of the mouth and airways is not required. Thermal control is important - keep the temperature in the delivery room at 26°C and wrap infants <28 weeks of gestation in plastic. However, this procedure does not reduce mortality. Since delayed cord clamping increases mean birth weight by approximately 30 g/kg, the present birth weight charts based on early clamping need to be corrected. Preterm infants in need of ventilatory support should start with CPAP from the first breath. A T-piece device seems to have some advantages compared to self-inflating bags. Surfactant instillation is often not needed prophylactically provided the mother has received antenatal steroids. Less invasive methods for administering surfactant may be useful. If ventilatory support is needed, start with air in term and near-term infants. For babies of 29-33 weeks of gestation start with 21-30% oxygen and for infants <29 weeks start with 30% oxygen and adjust according to the response obtained.

1.
Aune D, Saugstad OD, Henriksen T, Tonstad S: Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014;31:1536-1546.
2.
UNICEF/WHO: Fulfilling the Health Agenda for Women and Children. The 2014 Report. Geneva, WHO, 2014.
3.
Kamal SM: Decline in child marriage and changes in its effect on reproductive outcomes in Bangladesh. J Health Popul Nutr 2012;30:317-330.
4.
Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J: Searching for the optimal rate of medically necessary cesarean delivery. Birth 2014;41:237-244.
5.
Wilmink FA, Hukkelhoven CW, Lunshof S, Mol BW, van der Post JA, Papatsonis DN: Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J Obstet Gynecol 2010;202:250.e1-e8.
6.
Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB: Elective caesarean section and respiratory morbidity in the term and near-term neonate. Acta Obstet Gynecol Scand 2007;86:389-394.
7.
Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, Guinsburg R, Hazinski MF, Morley C, Richmond S, Simon WM, Singhal N, Szyld E, Tamura M, Velaphi S; Neonatal Resuscitation Chapter Collaborators: Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation 2010;122(suppl 2):S516-S538.
8.
WHO: Annual Report 2010. Geneva, WHO, 2010.
9.
Carlo WA, Goudar SS, Jehan I, Chomba E, Tshefu A, Garces A, Parida S, Althabe F, McClure EM, Derman RJ, Goldenberg RL, Bose C, Krebs NF, Panigrahi P, Buekens P, Chakraborty H, Hartwell TD, Wright LL; First Breath Study Group: Newborn-care training and perinatal mortality in developing countries. N Engl J Med 2010;362:614-623.
10.
Vento M, Cheung PY, Aguar M: The first golden minutes of the extremely-low-gestational-age neonate: a gentle approach. Neonatology 2009;95:286-298.
11.
Soll RF, Pfister RH: Evidence-based delivery room care of the very low birth weight infant. Neonatology 2011;99:349-354.
12.
Niermeyer S, Kattwinkel J, Van Reempts P, Nadkarni V, Phillips B, Zideman D, Azzopardi D, Berg R, Boyle D, Boyle R, Burchfield D, Carlo W, Chameides L, Denson S, Fallat M, Gerardi M, Gunn A, Hazinski MF, Keenan W, Knaebel S, Milner A, Perlman J, Saugstad OD, Schleien C, Solimano A, Speer M, Toce S, Wiswell T, Zaritsky A: International Guidelines for Neonatal Resuscitation: an excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines. Pediatrics 2000;106:E29.
13.
McCarthy LK, Morley CJ, Davis PG, Kamlin CO, O'Donnell CP: Timing of interventions in the delivery room: does reality compare with neonatal resuscitation guidelines? J Pediatr 2013;163:1553-1557.e1.
14.
Yao AC, Moinian M, Lind J: Distribution of blood between infant and placenta after birth. Lancet 1969;2:871-873.
15.
McDonald SJ, Middleton P, Dowswell T, Morris PS: Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2013;7:CD004074.
16.
Andersson O, Domellöf M, Andersson D, Hellström-Westas L: Effect of delayed versus early umbilical cord clamping on iron status and neurodevelopment at age 12 months: a randomized clinical trial. JAMA Pediatr 2014;168:547-554.
17.
Andersson O, Lindquist B, Domellöf M, Hellström-Westas L: Delayed cord clamping of term infants improves neurodevelopmental functions at four years of age: follow-up of a randomized trial. Abstract 3845.667, PAS, Vancouver, 2014.
18.
Rabe H, Diaz-Rossello JL, Duley L, Dowswell T: Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012;8:CD003428.
19.
Committee on Obstetric Practice, American College of Obstetricians and Gynecologists: Committee Opinion No 543: timing of umbilical cord clamping after birth. Obstet Gynecol 2012;120:1522-1526.
20.
Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Vento M, Halliday HL; European Association of Perinatal Medicine: European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2013 update. Neonatology 2013;103:353-368.
21.
Hutchon DJR: Immediate or early clamping versus delayed clamping. J Obstet Gynaecol 2012;32:724-729.
22.
March MI, Hacker MR, Parson AW, Modest AM, de Veciana M: The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial. J Perinatol 2013;33:763-767.
23.
Vain NE, Satragno DS, Gorenstein AN, Gordillo JE, Berazategui JP, Alda MG, Prudent LM: Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial. Lancet 2014;384:235-240.
24.
Brady JP, James LS: Heart rate changes in the fetus and newborn infant during labor, delivery, and the immediate neonatal period. Am J Obstet Gynecol 1962;84:1-12.
25.
Bhatt S, Alison BJ, Wallace EM, Crossley KJ, Gill AW, Kluckow M, te Pas AB, Morley CJ, Polglase GR, Hooper SB: Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 2013:591:2113-2126.
26.
Hooper SB, Polglase GR, te Pas AB: A physiological approach to the timing of umbilical cord clamping at birth. Arch Dis Child Fetal Neonatal Ed 2014, Epub ahead of print.
27.
Villar J, Cheikh IL, Victora CG, Ohuma EO, Bertino E, Altman DG, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Gravett MG, Purwar M, Frederick IO, Noble AJ, Pang R, Barros FC, Chumlea C, Bhutta ZA, Kennedy SH; International Fetal and Newborn Growth Consortium for the 21st Century (Intergrowth-21st): International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the Intergrowth-21st Project. Lancet 2014;384:857-868.
28.
Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM: Early weight loss nomograms for exclusively breastfed newborns. Pediatrics 2015;135:e16-e23.
29.
Saugstad OD: New growth charts for newborn babies. Lancet 2014;384:833-835.
30.
Carrasco M, Martell M, Estol PC: Oronasopharyngeal suction at birth: effects on arterial oxygen saturation. J Pediatr 1997;130:832-834.
31.
Kelleher J, Bhat R, Salas AA, Addis D, Mills EC, Mallick H, Tripathi A, Pruitt EP, Roane C, McNair T, Owen J, Ambalavanan N, Carlo WA: Oronasopharyngeal suction versus wiping of the mouth and nose at birth: a randomised equivalency trial. Lancet 2013;382:326-330.
32.
Vohra S, Roberts RS, Zhang B, Janes M, Schmidt B: Heat Loss Prevention (HeLP) in the delivery room: a randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants. J Pediatr 2004;145:750-753.
33.
Knobel R, Holditch-Davis D: Thermoregulation and heat loss prevention after birth and during neonatal intensive-care unit stabilization of extremely low-birthweight infants. Adv Neonatal Care 2010;10(suppl 5):S7-S14.
34.
Meyer MP, Hou D, Ishrar NN, Dito I, te Pas AB: Initial respiratory support with cold, dry gas versus heated humidified gas and admission temperature of preterm infants. J Pediatr 2015;166:245-250.
35.
McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S: Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database Syst Rev 2010;3:CD004210.
36.
Reilly MC, Vohra S, Rac VE, Dunn M, Ferrelli K, Kiss A, Vincer M, Wimmer J, Zayack D, Soll RF; Vermont Oxford Network Heat Loss Prevention (HeLP) Trial Study Group: Randomized trial of occlusive wrap for heat loss prevention in preterm infants. J Pediatr 2015;166:262-268.
37.
McCarthy LK, Molloy EJ, Twomey AR, Murphy JF, O'Donnell CP: A randomized trial of exothermic mattresses for preterm newborns in polyethylene bags. Pediatrics 2013;32:e135-e141.
38.
Rojas-Reyes MX, Morley CJ, Soll R: Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2012;3:CD000510.
39.
Szyld E, Aguilar A, Musante GA, Vain N, Prudent L, Fabres J, Carlo WA; Delivery Room Ventilation Devices Trial Group: Comparison of devices for newborn ventilation in the delivery room. J Pediatr 2014;165:234-239.
40.
Schmölzer GM, Kumar M, Aziz K, Pichler G, O'Reilly M, Lista G, Cheung PY: Sustained inflation versus positive pressure ventilation at birth: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2014, Epub ahead of print.
41.
Göpel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C, Siegel J, Avenarius S, von der Wense A, Vochem M, Groneck P, Weller U, Möller J, Härtel C, Haller S, Roth B, Herting E; German Neonatal Network: Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants [AMV]: an open-label, randomised, controlled trial. Lancet 2011;378:1627-1634.
42.
Klebermass-Schrehof K, Wald M, Schwindt J, Grill A, Prusa AR, Haiden N, Hayde M, Waldhoer T, Fuiko R, Berger A: Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology 2013;103:252-258.
43.
Göpel W, Kribs A, Härtel C, Avenarius S, Teig N, Groneck P, Olbertz D, Roll C, Vochem M, Weller U, von der Wense A, Wieg C, Wintgens J, Preuss M, Ziegler A, Roth B, Herting E; The German Neonatal Network (GNN): Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants. Acta Paediatr 2015;104:241-246.
44.
WHO: Guidelines on Basic Newborn Resuscitation. Geneva, WHO, 2012.
45.
Dawson JA, Kamlin CO, Vento M, Wong C, Cole TJ, Donath SM, Davis PG, Morley CJ: Defining the reference range for oxygen saturation for infants after birth. Pediatrics 2010;125:e1340-e1347.
46.
Saugstad OD, Aune D, Aguar M, Kapadia V, Finer N, Vento M: Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks. Acta Paediatr 2014;103:744-751.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.