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Neonatal Resuscitation. REFERENCES: ILCOR Guidelines – 2005 WHO Regional Credentialing Program. Objectives. Identify of infants “at risk” for asphyxia Discuss effects of asphyxia Describe Resuscitation of newborn Equipment Bag and mask ventilation Cardiac compressions

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neonatal resuscitation

Neonatal Resuscitation


ILCOR Guidelines – 2005

WHO Regional Credentialing Program

Pacific EmOC Program

  • 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 Program

how many infants might require active resuscitation
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 Program

antepartum risks
Maternal diabetes

Chronic maternal illness






Pre eclampsia

Maternal infection



Premature rupture of membranes


Fetal malformation

Maternal substance abuse

No antenatal care

Post term gestation

Multiple gestation


Age <16 or > 35

Antepartum Risks

Pacific EmOC Program

intrapartum risks
Emergency CS

Instrumental delivery

Abnormal position

Premature labour

Precipitous labour


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

Intrapartum Risks

Pacific EmOC Program

fetal asphyxia
Primary apnoea



Heart rate 

Resuscitate easily



White, floppy

Heart rate 

Blood pressure

Require active resuscitation eg IPPV to survive

Fetal asphyxia

Pacific EmOC Program

equipment needed for resuscitation
Radiant warmer

Warm towel and blankets

Resuscitation bag and mask

Self inflating bag

Anaesthetic bag

Endotracheal tubes



Oxygen source and tubing

Suction source and tubing

Drugs and fluids

Syringes, needles, cannulae, IV lines

+/-Umbilical lines

Equipment Needed for Resuscitation

Pacific EmOC Program

steps in resuscitation abcde
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 Program

steps in resuscitation abcde11
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)


    • Positioning
      • Supine or lateral
      • Head in neutral or slightly extended position

Pacific EmOC Program

steps in resuscitation abcde12
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 Program

breathing indications for positive pressure ventilation

Gasping respiration

HR < 100 bpm

Persistent central cyanosis despite 100% O2

40-60 breaths/min

No response

Breathing: Indications for positive pressure ventilation

Pacific EmOC Program

steps in resuscitation abcde14
Steps in Resuscitation - ABCDE
  • Circulation
  • Assessment of heart rate and response to previous measures
    • Umbilical arteries
    • Apex beat
    • Auscultation

Pacific EmOC Program

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

Chest Compressions

Pacific EmOC Program

steps in resuscitation abcde16
Steps in resuscitation - ABCDE


  • Adrenaline
  • Volume Expanders
  • Naloxone

Pacific EmOC Program

  • 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 Program

volume expanders
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 Program

  • 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 baby’s respirations for further respiratory depression

Pacific EmOC Program

steps in resuscitation abcde20

Reduce draughts

Shut doors and windows

Turn on radiant warmer

Warm blankets/bunny rugs/hat/plastic wrap for pre terms

Steps in resuscitation- ABCDE

Pacific EmOC Program

meconium liquor
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 Program