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

Learn about the principles of neonatal resuscitation, including the sequence of resuscitation and the importance of ventilation in newborns. Compare the sequence of resuscitation between adults and newborns.