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Neonatal resuscitation skills are important because of the potential for serious disability or death
in high-risk infants and in a few unpredicted full term low-risk deliveries. Careful review of
resuscitative procedures is important before problem deliveries arise.
I.
Preparation
A. Advanced preparation requires acquisition and maintenance of proper equipment and
supplies.
Mechanical Suction
8 Fr feeding tube and 20 cc syringe
Bag-and-Mask Equipment
Oral airways, newborn and premature
sizes
Infant resuscitation bag with a pressurerelease valve/pressure gauge to give 90100% O2
Intubation Equipment
Laryngoscope with straight blades, No.O
(preterm) and No.1(term newborn).
Extra bulbs and batteries for
laryngoscope
Endotracheal tubes, Size 2.5, 3.0, 3.5,
4.0 mm
Stylet
Scissors
Gloves
Medications
Epinephrine 1:10,000, 3 cc or 10 cc
ampules
Naloxone 0.4 mg/mL,1 mL ampules
Dextrose 10% in water, 250 cc
Sterile water, 30 cc
Miscellaneous
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Alcohol sponges
3-way stopcocks
3 Fr feeding tube
Umbilical tape
Needles, 25, 21, 18 gauge
Umbilical catheters 3 1/2 and 5 Fr
B. Immediate Preparation
1.
Suction, oxygen, proper-sized face mask and the resuscitation bag should be
checked.
2.
3.
1.
Bag-Mask ventilation. The infant should be in the supine position with head slightly
extended or neutral. The first ventilations should be given at a rate of 40-60/min.
Visible chest wall movement indicates adequate ventilation.
2.
Gestational Age
Size
Depth
<1000 g
<28 weeks
2.5 mm
7 cm
1000-2000 g
28-34 weeks
3.0 mm
8 cm
2000-3000 g
34-38 weeks
3.5 mm
9 cm
3000 g or more
39->40 weeks
4.0 mm
10 cm
If the heart rate is >100 beats/min, PPV can be discontinued after the infant is
breathing effectively. Support should be gradually withdrawn while observing for
adequacy of spontaneous breathing and heart rate.
2.
Chest compressions should be started if the heart rate is <80 beats/min, after 1530 seconds of adequate ventilation. PPV should also be continued.
a.
Compressions are applied to the lower sternum just below the nipple line, but
above the xiphoid process. The resuscitators thumbs are used to compress the
sternum while the fingers surround the chest, or the middle and index fingers
of one hand may be used to compress while the other hand supports the
infants back. The sternum is compressed to 3/4 inch.
b.
3.
Epinephrine should be given if the heart rate remains below 80/minute after 30
seconds of PPV and chest compressions.
Concentration
Preparation
Dosage
Rate/Precautio
ns
Epinephrine
1:10,000
1 mL
40 mL
0.1-0.3 mL/kg
Give rapidly.
IV or ET
May repeat in
with normal
3-5 min if HR
saline if given
is <80/min
via ET
10 mL/kg IV
Volume
Whole blood
expanders
Albumin 5%
min by syringe
Normal saline
or IV drip
Ringer lactate
Naloxone
0.4 mg/mL
1 mL
0.1 mg/kg
Give rapidly
(0.25 mL/kg)
IV, ET, IM, SQ
Naloxone
1.0 mg/mL
1 mL
1 mg/kg
IV, ET preferred
IM, SQ
ET, IM, SQ
acceptable
2 mEq/kg IV
Give slowly,
Sodium
0.5 mEq/mL
20 mL or two
bicarbonate
(4.2% solution)
10-mL prefilled
over at least 2
Diluted with
syringes
min.
sterile water to
make 0.5
mEq/mL
4.
Other Medications
a.
acute blood loss sufficient to cause shock and neonatal depression, much
larger volumes will be necessary and O-negative blood may be justified.
b.
c.
5.
2.
If meconium staining is detected, the infants mouth, nose, and posterior pharynx
should be suctioned thoroughly before the delivery of the shoulders and thorax.
Meconium should be removed before the first breath occurs.
3.
When meconium is thick and particulate and/or the infant is apneic or depressed,
the infant should be quickly intubated and suctioned endotracheally. The ET tube is
withdrawn slowly while continuing suction. Reintubation and suctioning should
continue until no more meconium is produced.
B. Preterm Infant Resuscitation. Infants weighing <1500 g are more likely to need
resuscitation. PPV and early intubation are usually required. ET tube placement is
necessary for all infants <1250 g.
IV. Post-resuscitation Management
A. Vital signs should be monitored and infants feedings withheld. Ten percent glucose is
often given IV.
B. The circulation, perfusion, neurologic status, and urine output should be monitored.
Moderate fluid restriction is usually instituted. A physical exam and lab studies, such as
blood gases, glucose, and hematocrit, should be completed.
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