Support of gas exchange in the delivery room and beyond: how do we avoid hurting the baby we seek to save?

With the availability of more sophisticated techniques for evaluating the premature neonate comes a parallel responsibility to carefully asses the process of resuscitation and assisted ventilation. The most fragile patients whom delivery room personnel are called to assist are the very low-birthweight preterm neonates. Their lung volumes are small, their chest walls are compliant, and their cerebral blood flow is low compared with term neonates. In this setting, everything that is done to the neonate must be performed with extreme caution and great care. This article discusses the causes of iatrogenic injury and suggests how such injury might be avoided.