Neonatal Resuscitation

How often do we use our resuscitation

skills?
Resuscitation
Algorithm:
 Suction
Equipment

Warmer &
Blankets

Bag, Mask,
& Oxygen
Laryngoscope
and ETT Tube
Universal Precautions
Assessment: Then
• Appearance
• Pulse
• Grimace
• Activity
• Respirations
Assessment: Now
Physiologic
Parameters Questions to ask yourself
(Apgar’s best) • Clear of Meconium?
• Breathing • Breathing or Crying?
• Heart Rate • Good Muscle tone?
• Color • Color Pink?
• Term Gestation?
Initial Management: For all deliveries

• Provide warmth
• Position and Clear Airway
• Dry
• Give Oxygen (as
necessary)
Positioning: Sniffing
The “Trusty” Bulb Syringe
Clear of
Meconium?
Self-Inflating Bag
O2 Reservoir

Pressure manometer
attaches
PEEP valve port

200-750ml Bag size

 Masks

Smallest sizes are for preterm infants

• Make sure the
airway is clear
• Lift the baby’s jaw
into the mask
• Keep the mouth
slightly open

Rate 40-60
Indications for Compressions
• Heart rate <60 • Coordinate with ventilation
▫ 4 events in 2 seconds

bpm after ▫ 90 compressions and 30

breaths per minute

30sec of PPV

One and Two and Three and Breathe

2 seconds
Compressions

2 thumb technique preferred

Return Demo: Basic Newborn Resuscitation
Situation: After drying and stimulation, the newborn remains
limp and is not breathing
Preparation for Resuscitation
• Call for help.
• Removed the first set of gloves and clamped and cut the cord.
• Explained calmly and gently to mother that newborn is having
difficulty breathing and needs help.
• Transfer the baby to clean, warm and dry surface for
resuscitation. Kept the newborn covered with a towel except for
the face, head and upper chest.
Return Demo: Basic Newborn Resuscitation
Procedure: SUNCTIONING
•Positioned the head in a slightly extended position to open the airway.
• Place a folded piece of cloth under the newborn’s shoulders to help
maintain the position.
• Cleared the airway by suctioning the mouth first and then the nose if the
mouth and nose were blocked by secretions.
• Gently introduce a suction tube 5cm into the newborn’s lips.
Suctioned while withdrawing the tube.
• Introduce the suction tube 3cm into each nostril. Suctioned while
withdrawing the tube.
• Repeat the suctioning if necessary ( not more than twice, not more
than 20 secs in total.
Return Demo: Basic Newborn Resuscitation
• If the newborn is still not breathing, start ventilating using bag and mask.
• Re-checked the position of the newborn’s head to make sure that the
neck is slightly extended.
• Placed the correct mask size on the newborn’s face to cover the chin,
mouth and nose.
• Formed a seal between the mask and the newborn’s face.
• Squeezed the newborn size bag attached to the mask and released the
bag two or three times.
• Observed for the chest rise.
• If the newborn has a chest rise, ventilate at the rate of 40-60 per minute.
Return Demo: Basic Newborn Resuscitation
• If the newborn has no chest rise, took steps to correct ventilation:
• Re applied face mask to improve the seal between the mask
and face.
• Cleared airway if obstructed by blood or mucus.
• Re-positioned the head to make sure neck is slightly
extended.
• Avoid pressure on the baby’s neck.
• Squeezed the bag harder to increase the pressure being given.
• Check for the distention of the stomach.
• Check for pneumothorax.
Return Demo: Basic Newborn Resuscitation
• Pause ventilation to check breathing; and check heart rate
after 1,5 and 10 minuutes.
• If heart rate is <60, is gasping or not breathing, has chest
indrawing or with inadequate chest rise.
• Take ventilation in corrective steps.
• Continue bag/mask ventilation.
• If feasible, gave supplemental oxygen, chest
compressions, other ventilator support and medications.
• Check the breathing and heart rate.
Return Demo: Basic Newborn Resuscitation
• If the baby starts breathing or crying and has no chest indrawing:
• Stopped ventilating
• Put the newborn to skin to skin contact on mother’s chest.
• Continue to care while monitoring the breath and warmth.
• Explain the condition of the baby to the mother.
• If after 10 minutes of effective ventilation, the heart rate remains to be 0
or if after 20 minutes of effective ventilation, the newborn does not start
to breathe or gasp at all and the heart rate is <60/min.
• Stopped ventilating
• Explain to the mother in a kind and gentle tone that the baby is
dead.
Return Demo: Basic Newborn Resuscitation
Post- Procedural Task
• Record of what had happened on the newborn’s note and on the
labor record:
• The date
• The time of resuscitation
• The resuscitation
• The outcome
• Clean and check the equipment in preparation for the next
birth.