Newly Born
History
Signs and Symptoms
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Due date and gestational age
Multiple gestation (twins etc.)
Meconium
Delivery difficulties
Congenital disease
Medications (maternal)
Maternal risk factors
substance abuse
smoking
Differential
Term Gestation
Breathing or Crying
Good Muscle Tone
Care of mother
Appropriate Protocol
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Respiratory distress
Peripheral cyanosis or mottling (normal)
Central cyanosis (abnormal)
Altered level of responsiveness
Bradycardia
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Airway failure
Secretions
Respiratory drive
Infection
Maternal medication effect
Hypovolemia
Hypoglycemia
Congenital heart disease
Hypothermia
Provide warmth / Dry infant
Clear airway if necessary
YES
Monitor and Reassess
NO
Warm, Dry and Stimulate
Clear airway if necessary
NO
Heart Rate < 100
Agonal breathing or Apnea
Labored breathing
Persistent Cyanosis
NO
YES
Airway Suctioning
YES
BVM Ventilations
B
Pulse Oximetry
P
Cardiac Monitor
Meconium present:
Non-vigorous newborns
may undergo
Direct Endotracheal
I
Suctioning
Heart Rate < 100
Supplemental Oxygen
Maintain SpO2 greater than or
equal to 94 %
NO
YES
Maintain warmth
BVM Ventilations
Monitor and Reassess
NO
Heart Rate < 60
YES
Pediatric and OB Protocols
Clear amniotic fluid:
Suction only when
obstruction is present and /
or if BVM is needed.
BVM Ventilations
Chest Compressions
Most newborns requiring
resuscitation will respond to
ventilations / BVM,
compressions and / or
epinephrine.
If not responding consider
hypovolemia,
pneumothorax and / or
hypoglycemia (< 40.)
I
IV / IO Procedure
Pediatric Airway Protocols
Heart Rate < 60
YES
NO
I
Epinephrine 1:10,000
0.01 mg IV / IO
Every 3 to 5 minutes as
needed
Normal Saline Bolus
10 mL / kg IV / IO
Notify Destination or
Contact Medical Control
Protocol 39
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS
2012
Newly Born
Approximately 10 % of newborns will require some assistance to begin breathing at birth.
Less than 1 % will require extensive resuscitation.
Initial Assessment:
Initial assessment should include is this a Term Gestation, is the newborn Crying or Breathing and does the newborn have good
Muscle Tone? If all three are present then general care should be utilized. Dry the baby and place skin-to-skin with mother and
cover with dry linen to maintain temperature.
If following the initial assessment you find the newborn is not Term, not Crying or Breathing and / or does not have good Muscle
Tone then the initial steps to stabilize the newborn will include:
1. Warm, dry, stimulate and clear airway if necessary.
2. BVM ventilations / oxygen.
3. Chest Compressions.
4. Administration of Epinephrine or Normal Saline Bolus.
The initial assessment should take about 60 seconds.
Temperature Control:
Important and becomes more important with low birth weight infants (<1500 g) and pre-term infants. For the low birth weight infant,
in addition to warming, drying, wrapping in dry linens, placing skin-to-skin with mother and providing a warm ambient environment
consider wrapping infant in saran type wrap.
Oxygen Utilization:
Oxygen saturations should be maintained at or above 94 %. Pulse oximetry may not be accurate initially. Pulse oximetry readings
will be low during the first 10 minutes of life. The pulse ox device should be place on the right arm / hand. Initial readings will range
from 60 – 75 % and by 5 to 10 minutes will rise to 85 – 95 %.
Initial Breaths and Ventilations:
Initial use of BVM may require up to 30 – 40 cmH2O pressure to establish a functional residual capacity. Use enough force to effect
a chest rise only. Assist ventilations at a rate of 40 – 60 per minute to effect a heart rate > 100 beats per minute.
Chest Compressions:
Ensure correct BVM, oxygenation and airway measures are optimal most infants require adequate breathing and oxygenation to
establish heart rate > 100. Compressions and ventilations should be coordinated to avoid simultaneous delivery. Compressions to
ventilations should be 3:1.
Pediatric and OB Protocols
Assessment of heart rate:
Should obtain by listening to the heart and feeling the umbilical pulse.
Epinephrine:
IV / IO is the preferred route of delivery. If access cannot be obtained then Epinephrine 1:10,000 0.1 mg / kg can be administered
via the endotracheal tube.
Hypoglycemia:
Give 10 mL / kg (typically 35 mL) of D10 IV / IO if Blood Glucose Analysis is less than 40.
Normal Saline Bolus:
If pre-term infant given 10 mL / kg over 5 minutes. Rapid infusion may precipitate cerebral hemorrhage.
Pearls
· Recommended Exam: Mental Status, Skin, HEENT, Neck, Chest, Heart, Abdomen, Extremities, Neuro
· CPR in infants is 120 compressions/minute with a 3:1 compression to ventilation ratio
· It is extremely important to keep infant warm
· Maternal sedation or narcotics will sedate infant (Naloxone NO LONGER recommended-supportive care only).
· Consider hypoglycemia in infant.
· Document 1 and 5 minute Apgars in PCR
· D10 = D50 diluted (1 ml of D50 with 4 ml of Normal Saline)
Protocol 39
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS
2012