Neonatal Resuscitation Principles

Overview and Principles of Neonatal Resuscitation

• Sequence of resuscitation in neonates: A-B-C (Airway, Breathing, Circulation)
• Ventilation of lungs is the most effective step in newborn resuscitation
• Etiology of neonatal compromise is nearly always a breathing difficulty

Newborn Resuscitation Pyramid

• Assess baby's risk for requiring resuscitation
• Provide warmth and dry the baby
• Position and clear airway if required
• Stimulate to breathe
• Give supplemental oxygen as required
• Assist ventilation with positive pressure
• Intubate the trachea (rarely needed)
• Provide chest compressions (rarely needed)

Signs of a Compromised Newborn

• Poor muscle tone
• Depressed respiratory drive
• Bradycardia
• Low blood pressure
• Tachypnea
• Cyanosis

In Utero or Perinatal Compromise

• Primary Apnea: initial period of attempted rapid breathing followed by primary apnea and dropping heart rate
• Secondary Apnea: continued fall in heart rate and blood pressure
• Resuscitation of a Baby in Secondary Apnea: initiation of effective positive-pressure ventilation

Provider Response

• All newborns require initial assessment to determine whether resuscitation is required
• Neonatal Resuscitation Algorithm (AHA 2015 Update)

Initial Steps

• Provide warmth
• Position head and clear airway as necessary
• Dry and stimulate the baby to breathe

Evaluation

• Evaluation of respirations, heart rate, and color
• 30 seconds to achieve a response from one step before deciding to go to the next

Breathing

• If apneic or HR < 100 bpm: provide positive-pressure ventilation (PPV) and Spo2 and ECG monitor
• If breathing, and heart rate is >100 bpm but baby is cyanotic: position and clear airway, Spo2 monitor, and give supplemental oxygen as needed (may use CPAP)

Circulation

• If heart rate <60 bpm: provide chest compressions

Medications

• Epinephrine: recommended dose is 0.01 to 0.03 mg/kg of 1:10,000 solution
• Give rapidly, can repeat every 3-5 minutes

Volume Expansion

• Indications: known or suspected blood loss, heart rate has not responded adequately to other resuscitative measures
• Recommended dose: 10 mL/kg over 5-10 minutes, may be repeated

Clearing the Airway

• When meconium is present: stay with the mother, initial steps of resuscitation under the radiant warmer
• Gentle clearing of meconium from mouth and nose with a bulb syringe if necessary

Resuscitation of Preterms

• Additional resources, personnel, and thermoregulation strategy
• Use of oximeter, blender to target Spo2 85%-95%
• Use of lower PIP 20-25 cm of H2O during PPV
• Consider giving CPAP and surfactant

Post Resuscitation Care

• Avoid hyperthermia, consider therapeutic hypothermia within 6 hours for >36 weeks and Acute perinatal HIE
• Monitor for apnea, bradycardia, BP, Spo2, and urine output
• Monitor B. Sugars, electrolytes, hematocrit, platelets, and ABG
• Maintain adequate oxygenation and support ventilation as needed