Neonatal Resuscitation - Preparation and Overview
Preparation:
- All health professionals dealing with newborn infants should be proficient in basic resuscitation; i.e. Airway, Breathing with mask ventilation, Circulation with cardiac compressions
- Additional skilled assistance is needed if the baby does not respond rapidly and should be called without delay
- A person proficient in advanced resuscitation (Airway, Breathing via tracheal ventilation, Circulation, Drugs) should be on site and available at short notice in a maternity unit at all times
- The need for resuscitation can usually be anticipated and a person proficient in advanced resuscitation should be in attendance at all high-risk deliveries
- A clock should be started at birth for accurate timing of changes in the infant's condition
- Keep the infant warm. Dry, remove wet towel and replace with dry one. This will also provide stimulation. Can place directly on mother's chest and covered if crying, good tone and colour and desired by the mother
- Resuscitation should be performed under a radiant warmer
- If preterm and weeks' gestation, to avoid heat loss, place the infant in a plastic bag without drying but under a radiant warmer and on a warming mattress. Leave the head exposed and cover with a woollen hat.
- Assess the infant's condition. Is the baby breathing or crying, good heart rate (120-160 beats/min, best assessed by listening with a stethoscope), good colour and muscle tone?
- If not, commence neonatal resuscitation
Overview:
- Dry the baby - Remove any wet towels and cover, Start-the clock or note the time
- Assess tone, breathing and heart rate
- If gasping or not breathing:
- Open the airway
- Give 5 inflation breaths
- Consider SpO2 monitoring
- Re-assess
- If no increase in heart rate look for chest movement
- If chest not moving:
- Recheck head postion
- Consider 2-person airway control and other airway manoeuvres
- Repeat inflation breaths
- Consider SpO2 monitoring
- Look for a response
- If no increase in heart rate look for chest movement
- When the chest is moving:
- If heart rate is not detectable or slow (< 60 / min)
- Start chest compressions - 3 compressions to each breath
- Reassess heart rate every 30 s
- If heart rate is not detectable or slow (< 60 / min) consider venous access and drugs
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