Neonatal

Resuscitation
Angelica Katrina O. Corpuz
Objectives
1. To review the physiologic events taking place at birth
2. To determine when to anticipate and prepare for high- risk deliveries
3. To be oriented with the different equipment used in neonatal
resuscitation
4. To describe the techniques involved in the resuscitation of the
newborn
5. To determine when to withhold and discontinue resuscitation

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Outline
I. Physiologic Events at Birth: A Review
II. Anticipation and Preparation
III. Equipment Used in Neonatal Resuscitation
IV. Neonatal Resuscitation
V. Post- Resuscitation Care

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Physiologic Events at Birth: A Review

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Anticipation and Preparation

Training
Competence
Teamwork

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Gomella’s Textbook of Neonatology, Eighth Edition, 2020
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 Complications of Pregnancy
Maternal Factors Fetal Factors
and Delivery
• Maternal age • Prematurity • Placental anomalies
• Diabetes • Postmaturity • Oligohydramnios/polyhyd
• Hypertension • Congenital ramnios
• Substance anomalies • Transverse/breech
abuse • Multiple gestations delivery
• Previous fetal • Chorioamnionitis
loss • Meconium-stained AF
• Urinary tract • Abnormal FHR
infection • Forceps/vacuum delivery
• Cesarean delivery

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Antenatal Counseling

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 Equipment Used in Neonatal Resuscitation

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 Equipment Used in Neonatal Resuscitation

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Equipment Used in Neonatal Resuscitation

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Neonatal Resuscitation Techniques

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PRESENTATION TITLE 14
Newborn Care

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Newborn Care

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Ventilatory Resuscitation

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 Ventilatory Resuscitation
Positive Pressure Ventilation (PPV)
Indicated for newborns who are:
• Apneic
• Gasping
• Bradycardic
Rate: 40- 60 breaths/ minute

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Ventilatory Resuscitation

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 Ventilatory Resuscitation
Positioning: SNIFFING POSITION
Best way to confirm effective
ventilation of the lungs?

CHECK FOR CHEST

WALL MOVEMENT

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 Ventilatory Resuscitation
Continuous Positive Airway Pressure (CPAP)
Indicated for newborns who are spontaneously breathing with a heart rate of
>100 beats/min who have either respiratory distress or low oxygen saturations

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 Ventilatory Resuscitation
Supplemental Oxygen
Indications:
• Newborns who are breathing but not maintaining oxygen saturations within
the target range
• Term neonates ≥35w AOG: 21% of oxygen is reasonable
• Preterm neonates <35w AOG: 21-30% of oxygen can be given but with
titration as needed

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 Ventilatory Resuscitation
Pulse Oximetry
Used to:
• Guide treatment when resuscitation is adapted
• Confirm cyanosis
• Monitor effectiveness of supplemental oxygen given
• If PPV is required

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Ventilatory Resuscitation

MR. SOPA
Mask reapplication
Reposition the head
Suction the airway
Open the mouth
increase the PIP, and
place an Advanced airway

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Ventilatory Resuscitation

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Ventilatory Resuscitation

Placement of an ETT or LMA

Indicated for NB with:
• Persistent apnea, gasping OR
• HR less than or equal to 60 breaths/
min despite effective PPV via face
mask OR
• Face mask ventilation still
unsuccessful after completion of the
MR SOPA steps.

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Ventilatory Resuscitation
Endotracheal Tube Intubation
Indications:
• Provide mechanical respiratory support.
• Administration of surfactant.
• Management of apnea.
• Alleviate upper airway obstruction (subglottic
stenosis).
• Assist in the management of congenital
diaphragmatic hernia to avoid bowel distention.
• Administer medications in the emergency setting.
• Obtain aspirates for culture.
• Assist in bronchopulmonary hygiene (“pulmonary
toilet”).
• Selective bronchial ventilation.
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 Endotracheal Tube Intubation
Equipment:
✓ Laryngoscope handle w/ Miller blade
▪ No. 1 for term
▪ No. 0 for preterm
▪ No. 00 for extremely preterm
✓ Suction apparatus & catheter
✓ Tape and scissors
✓ Tincture of benzoin
✓ Malleable stylet (optional)
✓ Personal protective equipment (PPE)
✓ Stethoscope
✓ Bag-and-mask apparatus
✓ Humidified oxygen/air source and blender
✓ Pressure manometer
✓ Colorimetric device or capnograph
✓ Mechanical ventilator
✓ Cardiorespiratory monitoring

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A B C

D E F

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Ventilatory Resuscitation
Endotracheal Tube Extubation

• Attempted when there is adequate

ventilation maintained with a minimal
PIP

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Ventilatory Resuscitation
Laryngeal Mask Airway
• Indicated when tracheal intubation is not
feasible due to lack of trained personnel
or not successful after a few attempts.
• Recommended for the resuscitation of
newborns ≥34 weeks’ gestation and
weighing ≥2000

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Chest Compressions

If the heart rate continues to be

<60 beats/min after 30 seconds of
effective positive-pressure ventilation
that moves the chest, chest compression
should be initiated.

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 Chest Compressions

90 compressions/min while
ventilating the infant at
30 breaths/min

Check HR every 60 seconds during

chest compressions, using a
3- Lead ECG

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Medications

2 Medications can be used:

1. Epinephrine
2. Volume Expanders

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 Medications
Epinephrine
• Indication: HR < 60 beats/ min despite adequate ventilation and chest
compressions for a minimum of 30 seconds
• MOA: via Peripheral vasoconstriction, resulting in an increased afterload to
the heart and retrograde filling of the coronary arteries.

Dose:
0.01 to 0.03 mg/kg (0.1–0.3 mL/kg) of 1:10,000 (1
mg/10 mL) solution given intravenously,
or 0.05 to 0.1 mg/kg (0.5–1 mL/kg) given by the ETT

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 Medications
Volume Expanders
• Indication: If there is a concern for Acute Hypovolemia or
Hypovolemic Shock

Recommended Volume Expanders:

• Normal Saline Solution (0.9% NaCl)
• Type- O negative PRBC

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 Medications
Volume Expanders
• Indication: If there is a concern for Acute Hypovolemia or
Hypovolemic Shock

Recommended Volume Expanders:

• Normal Saline Solution (0.9% NaCl)
• Type- O negative PRBC

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You have followed the Neonatal Resuscitation Program Algorithm, but
the newly born baby still has no detectable heart rate.
For how long should you continue?

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 The AAP and AHA state that
if there is no heart rate after 10 minutes of
adequate resuscitation efforts, discontinuation
of resuscitation efforts may be reasonable.

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Post- resuscitation Care
Glucose Regulation
• Intravenous glucose administration with Dextrose 10% in water or
with parenteral nutrition (to prevent HYPOglycemia)

Therapeutic Hypothermia
• Should be started after resuscitation in newborns >36 weeks’
gestation with clinical and laboratory evidence of moderate to
severe hypoxic ischemic encephalopathy (HIE).

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 Summary
1) Newborn resuscitation requires anticipation and preparation by providers who train
individually and as teams.
2) Inflation and ventilation of the lungs are the priority in newly born infants who need
support after birth.
3) A rise in heart rate is the most important indicator of effective ventilation and
response to resuscitative interventions.
4) are provided if there is a poor heart rate response to ventilation after Chest
compressionsappropriate ventilation corrective steps, which preferably include
endotracheal intubation.
5) The heart rate response to chest compressions and medications should be monitored
electrocardiographically.

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 Summary
5) If the response to chest compressions is poor, it may be reasonable to
provide epinephrine, preferably via the intravenous route.
6) Failure to respond to epinephrine in a newborn with history or examination
consistent with blood loss may require volume expansion.
7) If all these steps of resuscitation are effectively completed and there is no
heart rate response by 20 minutes, redirection of care should be discussed
with the team and family.

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