Neonatal Resuscitation

Asheber Gaym M.D.

January 2009
 Outline

• Discuss indications for neonatal resuscitation

• Outline equipments/essentials required for
neonatal resuscitation
• List steps and procedures of neonatal
resuscitation

Asheber Gaym,2009 2
 Indications for Neonatal Resuscitation

• A first minute apgar score less than 7

• Initial apgar score normal but subsequent
neonatal condition deteriorates and neonate
develops respiratory distress in the immediate
post partum period

Asheber Gaym,2009 3
 Equipments and other Essentials Required

Equipments Drugs Manpower

•Radiant warmer •Adrenalin1:10,000 •Skilled birth attendant
•Bulb suction solution ( midwife, obstetrician,
•Electrical suction •Sodium bicarbonate other providers trained on
•Neonatal face mask solution neonatal resuscitation)
•Dry towels •Normal saline
•Oxygen tank with •Naloxone
administration set up •Calcium gluconate
•Incubator if available
•Stethoscope
•Laryngoscope
•Neonatal endotracheal
tubes
•Neonatal ambu bag

Asheber Gaym,2009 4
 Steps and Procedures
Step and Procedure
Identify antepartum/intrapartum risk
factors for perinatal asphyxia
Upon delivery of the head before the first
breath
Following the delivery of the neonate
until the first minute ( as the neonate is
initiating breathing and adjusting to extra
uterine survival)
Asheber Gaym,2009
Description
•Intensify antepartum and intrapartum
surveillance
•Prepare essential equipments and
manpower for neonatal resuscitation
•Refer mother to facility where effective
neonatal resuscitation and care is
available (if one is practicing in a mid or
low level facility)
•Clean face with dry towel from secretions
and debris
•Suction the oropharynx first and
nasopharynx later if mechonium staining
is identified
•Dry neonate with warm towel under a
radiant warmer
•Assess first minute Apgar score
5
 Actions Based on First Minute Apgar Scores
>7 4-6 <3
•Normal apgar •Suction oral cavity and the nose •Initiate cardiac massage at a
score thoroughly before assisting with rate of 120 beats/min
•Wait until the ventilation •Intubation and continuous
fifth minute •If mechonium present, perform positive pressure ventilation
and if fifth laryngoscopy and if mechonium with 100% of oxygen at a rate
minute apgar present below vocal cord , tracheal of 40 breaths per minute
is still normal, suctioning performed as well. •Observe for improvements
perform a brief •Assess ventilation and if less than intermittently ( initiation of
exam for 40 /minute initiate ambu bag spontaneous respiration;
congenital ventilation to achieve 40-60 breaths color, heart rate)
anomalies and per minute. •Insert umbilical vein catheter
return neonate •Administer 100% oxygen through and administer normal saline
to mother. the ambu bag and sodium bicarbonate to
•Perform cardiac massage if counter acidosis and shock
necessary but often not required in respectively)
apgar scores of this range. •Adrenalin through
endotracheal tube

Asheber Gaym,2009 6