’Neonatal Resuscitation’ refers here to the systematic initial management of the newborn. This initial management is organized according to the ABCDE sequence. Assessments and treatments are carried out simultaneously.
- Initial Management
1-Dry the infant. The stimulation from drying the newborn is often enough to induce adequate breathing.
2-Assess breathing and tone. A child with vigorous regular breathing, normal tone and a heart rate > 100/min requires no other measures than preventing hypothermia.
3-Cord clamping should be delayed > 1 min if no resuscitation is required. The optimal timing of cord clamping if resuscitation is indicated is unknown.
1-Head in neutral position: if resuscitation is required, place the newborn supine with the head in neutral position (a towel placed under the shoulders may be required).
2-Jaw-thrust or oropharyngeal tube may be required to open the airway.
3-Airway suctioning (12-14 FG) is only required if the newborn is non-vigorous and thick meconium is present.
1-Ventilate the newborn with bag-valve-mask using room air at a rate of 30/min (1 second for each inflation). During the first 5 positive pressure inflations, maintain pressure for 2-3 sec.
2-Ensure that the chest passively rises with each inflation, otherwise reposition the airway and/or improve the seal of the mask.
1-Assess the heart rate using a stethoscope placed at the heart apex or an EKG.
2-Start chest compressions if the heart rate is < 60/min despite adequate ventilation:
- encircling the chest with the hands, two thumbs on the lower third of the sternum
- compression depth: 1/3 of the chest depth
- 3:1 compressions:ventilations with each ”event” 0.5 seconds (90 compressions/min)
3-Check the heart rate every 30 seconds. Discontinue chest compressions when the heart rate is > 60/min.
If the heart rate remains < 60/min despite adequate ventilation and chest compresssions, consider administering the following via an umbilical vein catheter or intraosseous needle:
- Adrenalin 1 mg/ml 10 µg/kg
- Crystalloid or blood 10 ml/kg
- Naloxone 1 mg/kg (can also be given intramuscularly)
- Consider terminating resuscitation if signs of life are absent despite > 15 min of resuscitation
- Therapeutic hypothermia should be offered to newborns with evolving moderate – severe hypoxic-ischemic encephalopathy.