Principles of Neonatal
Resuscitation
Outline
Routine care for all newborns
 ABCs of neonatal resuscitation
 Neonatal resuscitation guidelines
 Review questions
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Routine Care of Newborns at
Delivery
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Most babies require only simple, supportive care
The following steps should be taken to provide
supportive care to all newborns at the time of delivery:
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Dry baby with clean towel, including head, and keep infant warm!
Check for: good muscle tone, good crying effort and/or adequate
breathing, pink central color
If needed, help baby establish breathing!
Give baby to mother as soon as possible for skin to skin contact
Cover the baby to prevent heat loss
Initiate breast-feeding within 1 hr
Neonatal Resuscitation
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In some situations, the need for resuscitation might be anticipated,
for example:
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Mothers with pre-eclampsia
Multiple births
 Pre-term delivery
 Prolapsed cord
In these cases, it is CRITICAL to prepare equipment beforehand!
Resuscitation staff must be present at the moment the baby is born!
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But often, the need for resuscitation is not known prior to delivery,
therefore:
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Be prepared for resuscitation at every delivery!
 Every baby should be provided with routine supportive care at birth,
and be immediately assessed by a mid-wife, nurse, or doctor for the need
for further interventions
ABCs of Neonatal Resuscitation
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When approaching any sick infant or child,
priority should be to assess and support airway,
breathing and circulation
This is called the “ABC” approach
A: Open and stabilize the patient’s airway
B: Support patient’s efforts to breathe, or breathe for the
patient if necessary
C: Check pulse and perfusion, support cardiac output
as needed
ABC’s

This presentation will first review principles
of ABC’s, then discuss recommended
resuscitation guidelines
ABCs of Neonatal Resuscitation
A = Airway
Airway

Position infant in neutral position to open
airway
 Lay
baby flat on back, chin lifted up
 Do not hyperextend the neck as this will
compress airway
Opening the Airway
Right positioning
Wrong positioning:
Airway

Suction the Airway
 Oral
(and nasal) secretions should be suctioned
immediately with a bulb suction or other suction
device. This helps clear the airway AND provides
stimulation.
 Suck out debris and fluid from mouth, nose and
oropharynx
 Do not suck deep in the throat as this can cause
apnea and bradycardia
 Do not repeatedly suction nose as this can cause
swelling and obstruct the airway making breathing
more difficult
ABCs of Neonatal Resuscitation
B = Breathing
Breathing
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Assess infant’s effort to breathe
should have a good cry or good respirations –
grunting breaths or weak breaths are not adequate
 Patient

If infant is not breathing adequately, choose a
mask that covers nose and mouth, but not the
chin of the infant, in order to begin bag-andmask ventilation
 Size
0 for small infants
 Size 1 for normal weight infant
KEY TEACHING POINT! REMEMBER THIS!
 If
a newborn baby fails to breathe after
bulb suctioning, then
Positive Pressure Ventilation
with a Bag-and-Mask is the
single most important step
in neonatal resuscitation!
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Gently pull infant’s jaw forward to mask
Use a “C-grip” to hold mask to infant’s face,
using the 3rd finger to hold jaw up to mask
Breathing
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Check for an inadequate seal
 If
you can hear air escaping from the mask,
reposition the mask to form a better seal
between mask and face
 Most commonly, air escapes from openings
between nose and cheek
 Hold mask gently but firmly to infant’s face
Breathing
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Ventilate (bag) infant at a rate of 40-60 breaths per
minute
Goal with bag and mask ventilating is to give enough air
with each ventilation to move the chest
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Watch for chest to rise and fall
If the chest does not move with bagging:
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Check seal of mask
Reposition infant in the neutral position
Suction airway
Try giving larger breaths with the bag
Correct positioning
Watching for chest-rise- if chest is rising and falling
you are performing adequate ventilation
ABCs of Neonatal Resuscitation
C = Circulation
Circulation
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Check for pulse on infant
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Feel umbilical cord or brachial pulse
Or listen with stethoscope for heart rate
If heart rate is less than 60 beats/min, ensure that
effective ventilation is being administered!
If so, continue ventilation and begin compressions:
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Give 90 compressions/minute
Give in cycles: 3 compressions and 1 breath every 2 seconds,
then repeat, 3 compressions 1 breath
Place two thumbs on sternum, just below nipple line
Compress chest approximately 1/3 of the AP diameter
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Correct position of thumbs for chest compressions on
infant: two choices
Neonatal Resuscitation Guidelines:
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Dry the baby with a clean cloth
Check for:
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Breathing or crying
 Pink central color
 Good tone
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If all present, continue routine care
If baby does not have good respiratory effort, pink central color AND
good tone:
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Position infant in neutral position
Clear airway
Stimulate
Give oxygen if available
Neonatal Resuscitation Guidelines:
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If baby responds to positioning and stimulation by turning pink and
breathing, return to routine care
If baby does not respond to these measures within 30 seconds:
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Apply mask and ventilation bag to infant
Give 5 slow breaths
If baby responds and begins breathing, continue to observe closely,
return to giving routine care
If baby is not breathing after 5 slow breaths:
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Check position of infant
Continue bag and mask ventilation
Check to see if chest is rising: if there is no chest movement, suction
airway, reposition infant, then resume bag and mask ventilation
Neonatal Resuscitation Guidelines:
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If not breathing after 30 seconds:
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Check heart rate
If heart rate is > 60 beats per minute:
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Continue to ventilate at 40 breaths per minute
Use oxygen to ventilate if available
Watch for chest rise
Monitor position of infant
Stop ventilation every 1-2 mins to see if HR is greater than 60
beats per minute
Stop compressions if HR is > 100 beats per minute
Stop ventilations when breathing is > 30 breaths per minute
Continue oxygen therapy until infant is pink and has good tone
Neonatal Resuscitation Guidelines:
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If heart rate is < 60 beats per minute:
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Continue effective Positive Pressure Ventilation and
begin chest compressions at a rate of 90 compressions/minute
Continue chest compressions until HR>60 beats per minute
Continue to ventilate at 40 breaths per minute
Use oxygen to ventilate if available
Watch for chest rise
Monitor position of infant – should be neutral head position
Stop ventilation every 1-2 mins to see if HR is greater than 60 beats per
minute
Stop compressions if HR is > 100 beats per minute
Stop ventilations when breathing is > 30 breaths per minute
Continue oxygen therapy until infant is pink and has good tone
Neonatal Resuscitation Guidelines:
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Cessation of resuscitation
 If
after 20 minutes the baby is not breathing
and there is no pulse, the recommendation is
to stop resuscitation efforts
Review Questions

Immediate assessment of a newborn
should include which of the following?
 A.
Temperature
 B. Check if hands and feet are pink
 C. Check for crying or breathing
 D. Check pulse by umbilical cord
Review Questions
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All of the following steps should be
followed for all newborn infants except:
 A.
Drying infant thoroughly, including head
 B. Assessing baby for good breathing or
crying, good muscle tone, and pink central
color
 C. Bathing infant within first hour
 D. Initiating breast feeding within one hour
Review Questions

An infant is born with a weak cry, poor muscle tone and
bluish color on the abdomen. After drying with a clean
cloth and stimulating her, the infant has gasping breaths.
The next recommended step in the resuscitation of this
infant is:
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A. Place appropriate mask on infant and give 5 slow breaths
B. Check heart rate by feeling umbilical cord pulsations
C. Position head appropriately and suction airway if necessary
D. Continue to stimulate infant