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mortality; there is an association with slight increases in serum bilirubin level.
Based on the available evidence, the national recommendation is that DCC be
practiced when possible, for no longer than 30 seconds, for both term and preterm
infants who do not require resuscitation at birth. There is insufficient evidence to
make recommendations on cord clamping for infants who require resuscitation.
Evidence on cord milking is insufficient to suggest routine use in newly born
infants, and should be explicitly avoided in infants born at less than 29 weeks’
gestational age.

INTERVENTIONS
Oxygenation and Ventilation
Administration of Oxygen
Recent studies have shown improved survival for newborns resuscitated with
room air (21% oxygen at sea level) compared to 100% oxygen. Titrate
supplemental oxygen to achieve preductal SpO2 in the normal range values per
minute-of-life, as described in Figure 9.17 . This is applicable to the resuscitation
of term as well as preterm infants. Initiating resuscitation of preterm newborns
with high oxygen (>65%) is not recommended, as data has not demonstrated
benefit for the clinically important outcomes of IVH, bronchopulmonary
dysplasia (BPD), or retinopathy of prematurity (ROP). Deliver warm, humidified
oxygen when possible to maintain temperature.
Positive Pressure Ventilation
If initial management interventions are unsuccessful and the newborn is still not
breathing or is gasping, or the heart rate is less than 100 bpm, PPV must be
initiated. A flow-inflating or self-inflating bag may be used. Studies suggest that
addition of PEEP to resuscitation of newly born preterm infants does not lead to
more rapid improvement in HR, reduced need for ET intubation or chest
compressions, or improved mortality. However, there is evidence to support
decreased degree of supplemental oxygen necessary for resuscitation when using
PEEP, therefore when PPV is administered to preterm newborns, the use of 5 cm
H2 O PEEP is suggested. Success of ventilations is best judged by good chest

wall rise and breath sounds and heart rate response. An assisted ventilatory rate of
40 to 60 breaths/min will provide effective ventilation and oxygenation.
If BVM ventilation is required for longer than several minutes, an orogastric
tube should be placed to decompress the stomach. If respirations are restored and
the heart rate is >100 bpm, PPV may be slowly discontinued. If respirations