Resuscitation of the

newborn baby

Resuscitation: Key words

Anticipation

Fast

Preparation

Gentle

Help

Warmth

Record

Hygiene
Mother

Teaching Aids: ENC

NH- 2

Preparing for birth

Wash your hands

Draught free, warm room - temperature >250C

Clean, dry and warm delivery surface
Radiant heater
Two clean, warm towels/clothes
A folded piece of cloth
Self inflating bag - newborn size
Infant masks in two sizes - normal and small newborn
Suction device
Oxygen (if available)
Clock

Check if all equipments are in working order

Teaching Aids: ENC

NH- 3

Assessment at birth
Deliver

the baby on to mothers abdomen

Note and call out time of birth
Thoroughly dry the baby
Use a warm towel
Discard wet towel after drying
Wrap the baby in another warm cloth

Keep the baby warm

Assess

breathing while drying

Teaching Aids: ENC

NH- 4

Care of the baby at birth

Assess breathing:
Assessment
Baby is crying

Baby is not crying, but

breathing at 30 to 60 times per
minute
Baby is gasping
Baby is not breathing
Teaching Aids: ENC

Decision
No need for resuscitation or
suctioning;
Start skin-to-skin contact and
breastfeeding
No need for resuscitation or
suctioning
Start resuscitation immediately
Start resuscitation immediately
NH- 7

Scenario 1
A mother arrived at your maternity hospital and
delivered a baby girl as soon as she reached the
labor ward. The placenta followed the baby and
mother was not bleeding.

The baby was pale. He was breathing and heart

rate was 120/min.
What is the Action?

Teaching Aids: ENC

NH- 8

Dry the baby

immediately
after birth

Teaching Aids: ENC

NH- 9

Immediate
skin-to-skin
Contact &
Breastfeeding
(routine care)

Teaching Aids: ENC

NH- 10

Message 1
ONLY Routine care is required for a baby who
is crying or breathing normally;
Even routine suctioning is not required for
these normal babies

Teaching Aids: ENC

NH- 11

Scenario 2
A baby girl is born at your clinic after second stage
of 60 minutes. The umbilical cord is short.

You see that the skin is pale .She is not

breathing. Heart rate is over 100/min.
What is the Action?

Teaching Aids: ENC

NH- 12

Steps of resuscitation
If

the baby is not breathing or

gasping
Call

for help!
Cut cord quickly, transfer to a firm, warm
surface [under a radiant heater]
Inform the mother that baby has difficulty
breathing and you will help the baby to
breathe
Start newborn resuscitation

Teaching Aids: ENC

NH- 13

Steps of resuscitation
Position, clear airways

Teaching Aids: ENC

NH- 14

Steps of resuscitation
Position, clear airways

Teaching Aids: ENC

NH- 15

Steps of resuscitation
Position, clear airways (if needed)

Suction: Do not exceed duration of 20 sec

Teaching Aids: ENC

NH- 16

Steps of resuscitation
Dry, stimulate, reposition

Teaching Aids: ENC

NH- 17

Steps of resuscitation
Dry, stimulate, reposition

Teaching Aids: ENC

NH- 18

Steps of resuscitation
Dry, stimulate, reposition

Teaching Aids: ENC

NH- 19

Steps of resuscitation
Ventilate (if still not breathing)
Selecting Bag & Mask
equipment

Size of bag: 240-750 ml

Oxygen capability: Oxygen
source, reservoir
Safety feature: Pop off valve,
pressure gauge (optional)

Teaching Aids: ENC

NH- 20

Steps of resuscitation
Ventilate
Use the CORRECT size face
mask that covers:
The nose
The mouth
The tip of the chin
but not the eyes

Teaching Aids: ENC

NH- 21

Steps of resuscitation
Fitting a face mask:

A face mask that is too LARGE

Covers the eyes
Extends over the tip of the chin

A face mask that is too SMALL

Does not cover the nose

Does not cover the mouth effectively

Teaching Aids: ENC

NH- 22

Steps of resuscitation
Ventilate

Squeeze bag with 2 fingers or whole

hand, 2-3 times
Observe for rise of chest
IF CHEST IS NOT RISING:
Check seal
Reposition the head
Squeeze harder

Once good seal and chest rising,

ventilate at 40 squeezes per minute
Observe chest rise

Check heart rate after 30 seconds

Teaching Aids: ENC

NH- 23

Message 2
Bag and mask ventilation is required for a
baby NOT BREATHING or GASPING

Teaching Aids: ENC

NH- 24

Steps of resuscitation
When to stop ventilating?
If

baby is crying;
If breathing >30/min, and
NO chest in-drawing:
If

the skin between the ribs is

sucked inwards and the ribs
are prominent, the baby has
chest in-drawing

Teaching Aids: ENC

NH- 25

Steps of resuscitation
After stopping ventilation
Put the baby in skin-to-skin contact on
mothers chest
Monitor every 15 minutes for breathing and
warmth
Tell the mother the baby will probably be
well
Encourage the mother to start breastfeeding
as soon as possible
NEVER leave the baby alone

Teaching Aids: ENC

NH- 26

Steps of resuscitation
When to continue ventilating?
If the baby

is breathing at a rate of <30/min,

is gasping
has severe chest in-drawing

Arrange for immediate referral

Teaching Aids: ENC

NH- 27

Steps of resuscitation
Referral
Explain to the mother what happened, that her
baby needs help with breathing
Ventilate during the referral
Record the event on a referral form and labour
record

If the baby is NOT breathing even after 20

minutes, STOP ventilating

Teaching Aids: ENC

NH- 28

Scenario 3
Baby girl born at 38 weeks following thick
meconium stained amniotic fluid is
noted to be limp and not breathing .

The baby is blue. She was not breathing and

heart rate was 80/min.
What is the Action?

Teaching Aids: ENC

NH- 29

No need for intrapartum suction

Birth: assess
HR, breathing and tone
Vigorous: HR>100
good breathing

Nonvigorous: any
parameter abnormal

Good tone
Initial steps
Teaching Aids: ENC

Tracheal suction
NH- 30

Message 3
Meconium

stained depressed baby needs

endotracheal suction prior to B&MV

suction of oro-pharynx is not
recommended before delivery of shoulder

Routine

Teaching Aids: ENC

NH- 31

Scenario 4
Mother admitted in maternity unit delivered
a baby boy at 32 week gestation on bed.
The baby is limp and not breathing.

The baby is pale. He is not breathing and HR is

80/min.
What is the Action?

Teaching Aids: ENC

NH- 32

Steps of resuscitation
Special considerations for preterm

Be gentle
Use small size resuscitation bag and give small tidal
volumes to move chest
Avoid 100% oxygen , use blenders and oxygen
saturation monitors

Avoid rapid fluid bolus

May need intubation, chest compression, medications

Keep CPAP back up ready

Teaching Aids: ENC

NH- 33

Message 4
Preterm births need special precautions
before and during resuscitation

Teaching Aids: ENC

NH- 34

Post resuscitation management

Principles
1.
2.
3.
4.
5.
6.

Keeping normal temperature

Maintaining oxygenation
Maintaining physiological milieu- fluids , glucose
Maintaining perfusion
Treating seizures
Monitoring organ function

Teaching Aids: ENC

NH- 35

Care after resuscitation

Place baby in skin-to-skin contact with mother
Keep the baby warm
Monitor every 15 minutes
Start breastfeeding as soon as possible
Discuss what has happened with the parents - be
positive!
Do not separate the mother and baby unless the
baby has difficult breathing

Teaching Aids: ENC

NH- 36

Summary: Steps of resuscitation

1. Keep the baby warm: Place under the
radiant heater
2. Open the airway:
- Position babys head so it is slightly extended
- Suction the mouth and then the nose

3. If still not breathing: VENTILATE

4. If breathing or crying begins: STOP
VENTILATION

Summary: Steps of resuscitation

5. If breathing at <30 breaths per minute or
there is severe chest in-drawing: CONTINUE
VENTILATION
6. If no breathing or gasping after 20 minutes of
ventilation: STOP VENTILATION
7. Explain events to the mother and document

THANK YOU FOR YOUR

ATTENTION