Perinatal Management of Newborns in Out-of-Hospital Births

Unplanned out-of-hospital deliveries represent about 0.3% of all deliveries in France. The management of newborns in prehospital care by a mobile intensive care unit is part of the routine activity. The initial assessment of the newborn systematically includes measuring the heart rate (HR) and respiratory rate (RR), assessing the tone, and measuring the axillary temperature. In case of doubt or incomplete transition, cardiorespiratory monitoring will be immediately set up (HR, RR, SpO(2)). We review the known data and have adapted them, if necessary, to the out-of-hospital setting, as the majority of the data reported in the literature concerns maternity care or hospital care. We address essential points in the management of newborns, namely cardiopulmonary resuscitation, delayed umbilical cord clamping, the control of hypothermia and hypoglycaemia; as well as particular situations such as prematurity, meconium fluid, or congenital malformations. We also propose the equipment necessary for the management of newborns outside the hospital, different criteria for the engagement of an outof-hospital paediatric support as well as the techniques of ventilation and vascular access that the emergency physician must master. The objective of this update is to propose the most appropriate management of the prehospital setting.