Neonatal Resuscitation

REFERENCES:
ILCOR Guidelines 2005
WHO Regional Credentialing Program

Pacific EmOC Program

Objectives
Identify of infants at risk for asphyxia
Discuss effects of asphyxia
Describe Resuscitation of newborn

Equipment
Bag and mask ventilation
Cardiac compressions
Post resuscitation care

Pacific EmOC Progr

How many infants might require

active resuscitation?
10% require some degree of active
resuscitation
For up to 50% of this group there are no risk
factors
Staff attending deliveries may be faced with an
unexpectedly flat infant

Pacific EmOC Progr

Antepartum Risks
Maternal diabetes
Chronic maternal illness
Cardiovascular
Thyroid
Neurological
Pulmonary
renal
Pre eclampsia
Maternal infection
Polyhydramnios
Oligohydramnios

Premature rupture of
membranes
IUGR/preterm
Fetal malformation
Maternal substance abuse
No antenatal care
Post term gestation
Multiple gestation
Anaemia
Age <16 or > 35

Pacific EmOC Progr

Intrapartum Risks
Emergency CS
Instrumental delivery
Abnormal position
Premature labour
Precipitous labour
Chorioamnionitis
Prolonged rupture of
membranes
Prolonged labour > 24 hrs
Prolonged 2nd stage of
labour

Fetal bradycardia
Non-reassuring fetal heart
rate pattern
General anaesthesia
Narcotics administered
within 4 hours of delivery
Meconium stained liquor
Prolapsed cord
Abruptio placentae
Placenta previa

Pacific EmOC Progr

Fetal asphyxia
Primary apnoea

Apnoeic
Blue
Heart rate
Resuscitate easily

Secondary

apnoeic
White, floppy
Heart rate
Blood pressure
Require active
resuscitation eg IPPV
to survive

Pacific EmOC Progr

Always assume infant has secondary

Apnoea & commence Resuscitation

Pacific EmOC Progr

Equipment Needed for Resuscitation

Radiant warmer
Warm towel and blankets
Resuscitation bag and
mask

Self inflating bag

Anaesthetic bag

Endotracheal tubes
Laryngoscope
Stethoscope

Oxygen source and

tubing
Suction source and
tubing
Drugs and fluids
Syringes, needles,
cannulae, IV lines
+/-Umbilical lines

Pacific EmOC Progr

ILCOR Guidelines for

Neonatal
Resuscitation 2005

Pacific EmOC Progr

Steps in Resuscitation - ABCDE

Warmth and stimulation and assessment for
the 1st 30 seconds
Use warm cloth
Replace when wet
Rapidly assess

Tone
Colour
Respiratory effort

Pacific EmOC Progr

Steps in Resuscitation - ABCDE

Airway

Clear airway if required

Removal of secretions if present
Suction mouth and nose (only what you can see)
No more than 5cms for no longer than 5 secs
Negative pressure 100 mmHg (5litres)
DO NOT SUCTION IF AIRWAY IS CLEAR

Positioning
Supine or lateral
Head in neutral or slightly extended position

Pacific EmOC Progr

Steps in Resuscitation - ABCDE

Breathing
Assessment of respiratory effort and colour
Indications for oxygen administration
Cyanosis
Respiratory distress
Give free flowing oxygen 5L/min

Pacific EmOC Progr

Breathing: Indications for

positive pressure ventilation
Apnoea
Gasping respiration
HR < 100 bpm
Persistent central
cyanosis despite 100%
O2
40-60 breaths/min
No response
Pacific EmOC Progr

Steps in Resuscitation - ABCDE

Circulation
Assessment of heart rate and response
to previous measures
Umbilical

arteries

Apex

beat
Auscultation
Pacific EmOC Progr

Chest
Compressions
HR < 60 bpm despite
adequate vent with
100% O2 for 30
seconds
2 techniques
2 thumb (preferred)
2 finger
3:1 ratio
1/3 of AP diameter

Pacific EmOC Progr

Steps in resuscitation - ABCDE

Drugs
Adrenaline
Volume Expanders
Naloxone

Pacific EmOC Progr

Adrenaline
HR < 60 bpm after 30 seconds of
adequate ventilation and chest
compressions
0.1 - 0.3 mL kg of 1:10,000
Give via ETT, UVC, IV
Repeat dose if no response after 60
seconds
Pacific EmOC Progr

Volume expanders
Not given routinely
Useful in hypovolemia

Suspected where there is a pale tachycardic infant

Normal saline
10mL/kg over 5-10 mins
UVC, IV
If haemorrhagic shock is suspected give whole
blood or packed red cells
Pacific EmOC Progr

Naloxone
Narcotic antagonist
Inadequate spontaneous respiratory effort
Mothers who received narcotics within 4
hrs of delivery
0.1mg/kg of a 0.4 mg/mL solution
ETT, IV, UVC, IM, SC
Monitor babys respirations for further
respiratory depression
Pacific EmOC Progr

Steps in resuscitation- ABCDE

Environment
Reduce draughts

Shut doors and

windows
Turn on radiant
warmer
Warm blankets/bunny
rugs/hat/plastic wrap
for pre terms
Pacific EmOC Progr

Meconium liquor
ILCOR guidelines 2005 no evidence to suction mouth
and nose on perineum
If baby vigorous and crying - normal care & observation
If baby not vigorous view cords and suction trachea
under direct vision with laryngoscope & mec aspirator or
wide bore catheter
Cease suctioning if return is clear or Heart Rate 60
Observe post resuscitation for signs of respiratory distress

Pacific EmOC Progr