Neonatal resuscitation
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Neonatal resuscitation . Dr. S. Parthasarathy MD., DA., DNB, MD ( Acu ), Dip. Diab . DCA, Dip. Software statistics PhD ( physio ) Mahatma Gandhi Medical college and research institute , puducherry India . The need .

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Neonatal resuscitation

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Neonatal resuscitation

Dr. S. Parthasarathy

MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics PhD (physio)

Mahatma Gandhi Medical college and research institute , puducherry India

The need

  • Approximately 10% of newborns require some assistance to begin breathing at birth.

  • Less than 1% require extensive resuscitative measures

  • only 60% of asphyxiated newborns can be predicted antepartum.

The need is continuous

Initial queries ??

  • Term gestation?

  • Crying or breathing?

  • Good muscle tone?


  • the baby does not need resuscitation

  • should not be separated from the mother.

  • The baby should be dried, placed skin-to-skin with the mother, and covered with dry linen to maintain temperature.

  • Observation of breathing, activity, and color should be ongoing.


  • 1.Initial steps in stabilization (provide warmth, clear airway if necessary, dry, stimulate)

  • 2.Ventilation

  • 3.Chest compressions

  • 4.Administration of epinephrine and/or volume expansion

The golden minute

  • Approximately 60 seconds (“the Golden Minute”) are allotted for completing the initial steps, reevaluating, and beginning ventilation if required.

The goals of resuscitation

to assist

  • with the initiation and maintenance of adequate ventilation and oxygenation,

  • adequate cardiac output and tissue perfusion,

  • normal core temperature

  • serum glucose

To achieve goals, be ready

  • risk factors are identified early,

  • neonatal problems are anticipated,

  • equipment is available,

  • personnel are qualified and available

  • a care plan is formulated

Respiration equipment

  • Oxygen supply, Assorted masks

  • Neonatal bag and tubing to connect to an oxygen source

  • Manometer, Endotracheal tubes (2.5-4)

  • Tape and scissors

  • Laryngoscope (0 and 1 sized blades)

  • Extra bulbs and batteries

  • CO2 detectors

  • Stylettes for endotracheal tubes

  • Laryngeal mask Airway (optional)

Suction equipment

  • Bulb syringe

  • Regulated mechanical suction

  • Suction catheters (6F, 8F, 10F)

  • Suction tubing

  • Suction canister

  • Replogle or Salem pump (10F catheter)

  • Feeding tube (8F catheter)

  • Syringes catheter tipped – 20 ml

  • Meconium aspirator

Fluid equipment

  • Intravenous catheters (22 g)

  • Tape and sterile dressing material

  • Dextrose 10% in water (D10W)

  • Isotonic saline solution

  • T-connectors

  • Syringes, assorted (1-20 mL)

Advanced procedure ready

  • Umbilical catheters (2.5F, 5F)

  • Chest tube (10F catheter)

  • Sterile procedure trays

Trained Personnel

  • One present

  • Two or more

  • -- problems

  • --- twins

Temperature control

  • Dry and keep warm

  • Others

  • prewarming the delivery room to 26°C

  • 13 covering the baby in plastic wrapping

  • placing the baby on an exothermic mattress

  • the baby under radiant heat

  • prewarming the linen

  • The goal is to achieve normothermia and avoid iatrogenic hyperthermia

Temperature range

  • Normal 36.5-37.5o C Continue

  • Potential cold stress 36-36.5o C concern

  • Moderate hypothermia 32-36o C Danger

  • Severe hypothermia < 32o C

  • Outlook grave, skilled care urgently needed


  • Clear liquor

  • Meconium stained liquor

Clear liquor – suctioning routine ??

  • be associated with worsening of pulmonary compliance and oxygenation

  • reduction in cerebral blood flow velocity when performed routinely (ie, in the absence of obvious nasal or oral secretions)

  • Apnea, bradycardia, hypotension, and laryngospasm

  • Think about routine suctioning ??

Clear liquor – suctioning routine ??

  • suctioning immediately following birth (including suctioning with a bulb syringe) should be reserved for babies who have obvious obstruction to spontaneous breathing or who require positive-pressure ventilation (PPV)

What is routine

  • Drying and suctioning ,

  • If no response,

  • more vigorous stimulation, slapping the soles of the feet or rubbing the back.

  • The back should be visualized.

  • If there is no response to stimulation,

  • it may be assumed the infant is in secondary apnea, and PPV should be initiated.

  • infant's respiratory rate, heart rate, and color should be evaluated

Meconium stained liquor

  • Historically

  • Suction before delivery of shoulders –

  • not proved useful

  • routine endotracheal intubation and direct suctioning of the trachea ??

  • No to active crying babies !!

Mec. staining

  • endotracheal suctioning of nonvigorous babies with meconium-stained amniotic fluid

  • If intubation difficult and causing brady , don’t try – go back to mask ventilation

Administration of Oxygen

  • Oxyhemoglobin saturation may normally remain in the 70% to 80% range for several minutes following birth

  • clinical assessment of skin color is a very poor indicator of oxyhemoglobin saturation

SPO2 monitor

  • a preductal location (ie, the right upper extremity, usually the wrist or medial surface of the palm).

  • Term infants keep SaO2 – 90- 94%

  • Preterm – 88-92%

  • 8- 10 litres- oxygen Hood

  • Monitor progress


  • unheated non humidified oxygen sources for the bag-valve-mask device

  • Intubated ventilated patient – humidified warmed ventilator circuits

Positive pressure ventilation

  • If the infant remains apneic or gasping,

  • or

  • if the heart rate remains <100 per minute after administering the initial steps.

  • Assisted ventilation rates of 40 to 60 breaths per minute

  • Heart rate , SPo2, monitor


  • CPAP

  • recommend administration of continuous positive airway pressure (CPAP) to infants who are breathing spontaneously,

  • but with difficulty, following birth, although its use has been studied only in infants born preterm

Laryngeal mask airways and PPV

  • Laryngeal mask airways that fit over the laryngeal inlet - effective for ventilating newborns

  • weighing more than 2000 g

  • delivered ≥34 weeks gestation

  • meconium-stained fluid,

  • during chest compressions,

  • or for administration of emergency intratracheal medications

Endotracheal Tube Placement

  • Initial endotracheal suctioning of nonvigorousmeconium-stained newborns

  • If bag-mask ventilation is ineffective or prolonged

  • When chest compressions are performed

  • For special resuscitation circumstances, such as congenital diaphragmatic hernia or extremely low birth weight

Effective ventilation

  • Heart rate

  • CO2

  • SPo2

Chest Compressions

  • Chest compressions are indicated for a heart rate that is <60 per minute despite adequate ventilation with supplementary oxygen for 30 seconds

  • Ventilation priority

  • the 2 thumb–encircling hands technique

  • the 2-finger technique,


  • Drugs are rarely indicated in resuscitation of the newly born infant.

  • Bradycardia in the newborn infant is usually the result of inadequate lung inflation or profound hypoxemia

  • Atropine ???


if the heart rate remains <60 per minute despite adequate ventilation (usually with endotracheal intubation) with 100% oxygen and chest compressions, administration of epinephrine or volume expansion, or both, may be indicated.

  • The recommended IV dose is 0.01 to 0.03 mg/kg per dose

Drugs and infusions

  • Rarely, buffers, a narcotic antagonist, or vasopressors may be useful after resuscitation, but these are not recommended in the delivery room.

  • An isotonic crystalloid solution – 10 ml /Kg

  • Intravenous glucose infusion should be considered as soon as practical after resuscitation, with the goal of avoiding hypoglycemia

Discontinue resuscitation

  • In a newly born baby with no detectable heart rate, it is appropriate to consider stopping resuscitation if the heart rate remains undetectable for 10 minutes

After reading neonatal resuscitation

  • What is shocking ??

  • NO APGAR score at all.

The Apgar score

  • Evaluate the newborn baby on five simple criteria on a scale from zero to two,

  • then summing up the five values thus obtained.

  • The resulting Apgar score ranges from 0 to 10.

  • The five criteria are summarized using words chosen to form a backronym

  • (Appearance, Pulse, Grimace, Activity, Respiration.)


0 1 2

  • Appearance - red peri. Blue total blue

  • Pulse ? < 100 > 100

  • Grimace mild active

  • Active tone less flexion good resist

  • Respir. Absent weak ,gasps active cry

APGAR score

  • Score of 10 ??

  • >7 ok

  • 4 – 7 -- to act

  • 1 min, 5 , 10, 15 minutes

  • Score of 3 0r less persistent – neuro damage

What we do - follows ??

Prewarm clothes

Tray, oxygen weighing machine


Bulb syringe

Gentle back massage

Ryles tube and aspiration

Inj. Vit. K , temperature monitoring with hood oxygen

Breast feeds

Thank you all

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