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Neonatal Resuscitation

*THIS IS A BASIC FRAMEWORK AND IS NOT COMPREHENSIVE*

  1. EVALUATE
    • Is the newborn crying/breathing spontaneously? Does the newborn have good tone? Is the newborn a term infant?
      • If YES, hand baby to mom for direct skin-to-skin.
      • If NO, proceed to step 2.
  2. INTERVENE
    • STIMULATE – dry vigorously
    • WARM – place cap on head, place in warmer
    • OPEN AIRWAY – sniffing position, oral/nasal airway, suction if necessary
  3. ASSESS HR (manually)
    • If HR>100, continue above interventions and move to PPV if not improving/if pulse ox low
    • If HR 60-100, attach to telemetry and pulse oximetry and begin PPV with room air at a rate of 60.
    • If HR<60, this is a CODE situation. Chest compressions and ventilations in a 3:1 ratio (“one and two and three and breath”), use PPV with 100% FiO2. Obtain access via UC or IO line, and intubate. Use epinephrine / fluid bolus if no improvement in 60 seconds. Check glucose, supplement with dextrose if necessary.

PEARL: At one minute of life, we expect an SpO2 of 60%.  Every minute afterwards, we expect the SpO2 to increase by 5%, so by 5 minutes of life it should be around 80%.  

Neonatal Resuscitation – Emergency Medicine Cases