Neonatal Resuscitation
REFERENCES:
ILCOR Guidelines – 2005
WHO Regional Credentialing Program
Pacific EmOC Program
Objectives
• Identify of infants “at risk” for asphyxia
• Discuss effects of asphyxia
• Describe Resuscitation of newborn
– Equipment
– Bag and mask ventilation
– Cardiac compressions
– Post resuscitation care
Pacific EmOC Program
How many infants might require
active resuscitation?
10% require some degree of active
resuscitation
For up to 50% of this group there are no “risk
factors”
 Staff attending deliveries may be faced with an
unexpectedly “flat” infant
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Pacific EmOC Program
Antepartum Risks
Maternal diabetes
Chronic maternal illness
 Cardiovascular
 Thyroid
 Neurological
 Pulmonary
 renal
Pre eclampsia
Maternal infection
Polyhydramnios
Oligohydramnios
Premature rupture of
membranes
IUGR/preterm
Fetal malformation
Maternal substance abuse
No antenatal care
Post term gestation
Multiple gestation
Anaemia
Age <16 or > 35
Pacific EmOC Program
Intrapartum Risks
Emergency CS
Instrumental delivery
Abnormal position
Premature labour
Precipitous labour
Chorioamnionitis
Prolonged rupture of
membranes
Prolonged labour > 24 hrs
Prolonged 2nd stage of
labour
Fetal bradycardia
Non-reassuring fetal heart
rate pattern
General anaesthesia
Narcotics administered
within 4 hours of delivery
Meconium stained liquor
Prolapsed cord
Abruptio placentae
Placenta previa
Pacific EmOC Program
Fetal asphyxia
Primary apnoea
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Apnoeic
Blue
Heart rate 
Resuscitate easily
Secondary
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Pacific EmOC Program
apnoeic
White, floppy
Heart rate 
Blood pressure
Require active
resuscitation eg IPPV
to survive
Always assume infant has secondary
Apnoea & commence Resuscitation
Pacific EmOC Program
Equipment Needed for Resuscitation
Radiant warmer
Warm towel and blankets
Resuscitation bag and
mask
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Self inflating bag
Anaesthetic bag
Endotracheal tubes
Laryngoscope
Stethoscope
Oxygen source and
tubing
Suction source and
tubing
Drugs and fluids
Syringes, needles,
cannulae, IV lines
+/-Umbilical lines
Pacific EmOC Program
ILCOR Guidelines for
Neonatal Resuscitation
2005
Pacific EmOC Program
Steps in Resuscitation - ABCDE
Warmth and stimulation and assessment for
the 1st 30 seconds
Use warm cloth
 Replace when wet
 Rapidly assess

Tone
 Colour
 Respiratory effort
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Pacific EmOC Program
Steps in Resuscitation - ABCDE
Airway
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Clear airway if required
Removal of secretions if present
Suction mouth and nose (only what you can see)
 No more than 5cms for no longer than 5 secs
 Negative pressure 100 mmHg (5litres)
DO NOT SUCTION IF AIRWAY IS CLEAR
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Positioning
Supine or lateral
 Head in neutral or slightly extended position
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Pacific EmOC Program
Steps in Resuscitation - ABCDE
Breathing
Assessment of respiratory effort and colour
Indications for oxygen administration
Cyanosis
 Respiratory distress
 Give free flowing oxygen 5L/min
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Pacific EmOC Program
Breathing: Indications for
positive pressure ventilation
Apnoea
Gasping respiration
HR < 100 bpm
Persistent central
cyanosis despite 100%
O2
40-60 breaths/min
No response
Pacific EmOC Program
Steps in Resuscitation - ABCDE
Circulation
Assessment of heart rate and response
to previous measures
 Umbilical
arteries
 Apex
beat
 Auscultation
Pacific EmOC Program
Chest
Compressions
HR < 60 bpm despite
adequate vent with
100% O2 for 30
seconds
 2 techniques
2 thumb (preferred)
 2 finger
 3:1 ratio
 1/3 of AP diameter
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Pacific EmOC Program
Steps in resuscitation - ABCDE
Drugs
Adrenaline
Volume Expanders
Naloxone
Pacific EmOC Program
Adrenaline
HR < 60 bpm after 30 seconds of
adequate ventilation and chest
compressions
0.1 - 0.3 mL kg of 1:10,000
Give via ETT, UVC, IV
Repeat dose if no response after 60
seconds
Pacific EmOC Program
Volume expanders
Not given routinely
Useful in hypovolemia
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Suspected where there is a pale tachycardic infant
Normal saline
10mL/kg over 5-10 mins
UVC, IV
If haemorrhagic shock is suspected give whole
blood or packed red cells
Pacific EmOC Program
Naloxone
Narcotic antagonist
Inadequate spontaneous respiratory effort
Mothers who received narcotics within 4
hrs of delivery
0.1mg/kg of a 0.4 mg/mL solution
ETT, IV, UVC, IM, SC
Monitor baby’s respirations for further
respiratory depression
Pacific EmOC Program
Steps in resuscitation- ABCDE
Environment
Reduce draughts
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Shut doors and
windows
Turn on radiant
warmer
Warm blankets/bunny
rugs/hat/plastic wrap
for pre terms
Pacific EmOC Program
Meconium liquor
ILCOR guidelines 2005 – no evidence to suction mouth
and nose on perineum
If baby vigorous and crying - normal care & observation
If baby not vigorous – view cords and suction trachea
under direct vision with laryngoscope & mec aspirator or
wide bore catheter
Cease suctioning if return is clear or Heart Rate  60
Observe post resuscitation for signs of respiratory distress
Pacific EmOC Program