NEONATAL RESUSCITATION

Presented by : Dr. Harish Uppala

Chairperson : Dr. kousalya
Moderator : Dr. Hemnath
 INTRODUCTION

• The successful transition from intrauterine to

extrauterine life is dependent upon significant
physiologic changes that occur at birth.
• Although most newborns successfully make this
transition at delivery without requiring any
special assistance
• A small but significant number will require
additional support, including resuscitation in the
delivery room
 ANTICIPATION
• Maternal conditions – Advanced or very young maternal age, maternal
diabetes mellitus or hypertension, maternal substance use disorder, or
previous history of stillbirth, fetal loss, or early neonatal death.

• Fetal conditions – Prematurity, postmaturity, congenital anomalies,

intrauterine growth restriction, or multiple gestations.

• Antepartum complications – Placental anomalies (eg, placenta previa or

placental abruption), or presence of either oligohydramnios or
polyhydramnios.

• Delivery complications – Transverse lie or breech presentation,

chorioamnionitis, foul-smelling or meconium-stained amniotic fluid,
antenatal asphyxia with abnormal fetal heart rate pattern, maternal
administration of a narcotic within four hours of birth, deliveries that require
instrumentation (eg, forceps or vacuum deliveries) or cesarean delivery for
maternal or fetal compromise.
APGAR SCORE
 ASSESSMENT
● Is the infant full-term?
● Does the infant have good muscle tone?
● Is the infant breathing or crying?

If the answer to all three questions is yes,

the newborn does not need resuscitation,
should not be separated from the mother,
and is managed by routine neonatal care.
 Initial steps

During the first minute of life, referred to as the "golden

minute," all newborn infants are initially assessed to
determine the level of care needed and the following
initial steps of stabilization are completed

• Warm and maintain body temperature

• Position airway and clear secretions if needed

• Dry the infant

• Stimulation
 ASSESS
• Apnea/ gasping ?
• Heart rate < 100 ?
 Labored breathing or persistent cyanosis and heart rate
≥100 bpm,the following interventions are performed
within one minute after delivery.

● Position and clear airway

● Use of pulse oximetry to monitor SpO2
● Provide supplemental oxygen to targeted preductal
SpO2
● Consider the use of continuous positive airway pressure
 Apnea/gasping and heart rate <100 bpm — For infants who are
apneic or gasping and have a heart rate below 100 beats per
minute (bpm), the following interventions are performed within
one minute after delivery:

• Positive pressure ventilation (PPV) at a rate of 40 to 60 breaths

per minute

• Monitor with pulse oximetry, which provides a noninvasive, rapid,

and continuous assessment of heart rate during resuscitation and
measures oxygen saturation (SpO2)

• Electrocardiographic monitoring
After the initial 15 seconds of PPV.

1. If the heart rate is not increasing, evaluate for chest rise with assisted
breaths, if the chest is not rising appropriately with administered breaths,
perform ventilation corrective steps [4]. These include:

• Mask readjustment

• Reposition airway by ensuring correct head position

• Suction mouth and nose

• Open the mouth and tilt the jaw forward

• Pressure increase using increments of 5 to 10 cm H2O to maximum of

40 cm H2O

• Alternative airway using endotracheal intubation or laryngeal mask

2. If the heart rate is increasing, continue PPV and check the heart rate
again after 15 seconds. The need for additional interventions is
based on the heart rate after a total of 30 seconds of PPV as follows

• Heart rate is ≥100 bpm and spontaneous effective respiration has

begun, PPV can be discontinued and free-flowing oxygen can be
administered as needed based on the target SpO after birth.

• If the heart rate remains <100 bpm, continue PPV ventilation and
check for chest wall movement to see if there is effectively delivered
ventilation. If not, assess and correct ventilation technique. If
needed, proceed to endotracheal intubation or use of a laryngeal
mask airway.
3. If the heart rate is <60 bpm

• Intubate the infant or place a laryngeal mask airway if

this has not already been done, initiate chest
compression and reassess that adequate positive
pressure ventilation is being delivered. (3:1)

• If the heart rate remains <60 bpm, obtain vascular

access and administer intravenous epinephrine.
Consider whether the infant is hypovolemic and requires
volume expansion, or if a there is a pneumothorax
 POSTRESUSCITATION
COMPLICATIONS
● Hypo- or hyperthermia
● Hypoglycemia
● Central nervous system (CNS) complications: apnea,
seizures, or hypoxic ischemic encephalopathy
●Pulmonary complications: Pulmonary hypertension,
pneumonia, pulmonary air leaks, or transient tachypnea
of the newborn
● Hypotension
● Electrolyte abnormalities Feeding difficulties: Ileus,
gastrointestinal bleeding, or dysfunctional sucking or
swallowing
 SPECIAL CONDITIONS
MECONIUM STAINED LIQUOR
• If baby is vigorous resuscitation should follow the same
principles for infants with meconium-stained fluid as for
those with clear fluid
• Routine intubation for tracheal suction in this setting is
not suggested
• If poor muscle tone and inadequate breathing effort are
present, the initial steps of resuscitation should be
completed under an overbed warmer
• PPV should be initiated if the infant is not breathing or
the heart rate is less than 100/min after
the initial steps are completed
 EQUIPMENT
● Radiant warmer is turned on

● Oxygen source is open with adequate flow through

the tubing

● Suctioning apparatus is functioning properly

● Laryngoscope is functional with a bright light

● Testing of resuscitation bag and mask demonstrates

an adequate seal and generation of pressure