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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 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 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