Newborn Resuscitation

OVERVIEW

Priorities:

• correction of hypoxia (most common cause of neonatal arrest)
• decreased risk of meconium aspiration
• support circulation

INITIAL ACTIONS

• Declare emergency
• Call for help (neonatal/paediatric registrar or consultant)
• Move baby to resuscitare
• Stimulate baby by drying

AIRWAY

• open airway and assess for patency (suction if required)
• if this baby doesn’t respond quickly will probably need intubation (appropriate size for term neonate = 3.5, intubate and place tip of ETT just beyond cords – ensure adequately ventilating both lungs, length @ lips should be 9cm)
• if meconium soiling airway intubate and suction down ETT before ventilating

BREATHING

• administer 100% O2 via bag-mask (5 effective breaths)
• provide PEEP
• watch for spontaneous breathing
• if no respiratory effort give IPPV until HR >100

CIRCULATION

• pulse = 60/min -> institute chest compression (3:1) @ rate of 100/min with thumbs around chest
• begin to obtain IV access by placing an IV cannula into the umbilical vein or interossous needle insertion
• administer adrenaline (0.1mL/kg o 1:10,000 – the average full term neonate = 3.5kg thus administer 0.35mL IV or 3.5mL into trachea)
• give an IV normal saline bolus of 70mL (20mL/kg)
• attach ECG if not responding ? shockable rhythm

DISABILITY

• send bloods for cord pH and ABG
• check glucose (dextrose 10% 5mL/kg)
• consider naloxone 200mcg IM
• consider NaHCO3 4.2% 1mmol/kg = 3.5mmoL

EXPOSURE/ ENVIRONMENT/ EVERYTHING ELSE

• keep warm and dry
• make sure wet towels are removed quickly and replaced with warm ones

• Constantly reassess airway, breathing, circulation, disability and exposure
• Transfer to neonatal unit for ongoing assessment and treatment