Neonatal Resuscitation (age <28 days) Administrative Guideline)

Question 1

Term gestation?
Breathing or crying?
Good tone?
YES?

Answer 1

Routine Care
- Provide warmth
- Ensure open airway, suction
only as necessary
- Dry
- Ongoing evaluation

Question 2

Term gestation?
Breathing or crying?
Good tone?
NO?

Answer 2

Warm, open airway, dry stimulation

Question 3

HR below 100/min?
Gasping or apnea?
NO?

Answer 3

Labored breathing or
cyanosis? NO? Then do routine care
YES
Clear airway/suction as necessary
Cardiac monitor, pulse-oximetry
Then monitor and continue supportive care

Question 4

HR below 100/min?
Gasping or apnea?
YES?

Answer 4

Provide positive pressure ventilation

Cardiac monitor, pulse-oximetry

Question 5

HR below 60/min?

NO?

Answer 5

Monitor and continue supportive care
Transport per SAEMS Critical Pediatric Triage Protocol and
notify receiving facility

Question 6

HR below /min?

YES?

Answer 6

Begin chest compressions
Coordinate with ventilations
Rhythm and pulse check every 2 minutes

IV/IO access
Administer epinephrine (1 mg/10 mL) 0.01 mg/kg IV/IO
- May repeat x 1
Administer 10 mL/kg IV/IO NS/LR bolus
(post-resuscitative care)

Question 7

Targeted preductal (RUE) SpO2 after birth

Answer 7

1 min: 60-70%
2 min: 65-85%
3 min: 70-90%
4 min: 75-90%
5 min: 80-90%
10 min: 85-90%

Question 8

How long do you wait before clamping and cutting the umbilical cord?

Answer 8

30-60 seconds

Question 9

How long do you warm and dry and stimulate?

Answer 9

30 seconds

Question 10

If heart rate > 100 beats per minute:

Answer 10

• Monitor for central cyanosis and provide blow-by oxygen as needed.
• Monitor for signs of respiratory distress. If apneic or in significant respiratory distress, initiate BVM with
  room air at 40-60 breaths per minute.

Question 11

If heart rate < 100 beats per minute:

Answer 11

• Initiate BVM ventilations with room air at 40-60 breaths per minute while monitoring heart rate closely.
• If no improvement after 90 seconds, change O2 delivery to 100% FiO2 until HR normalizes

Question 12

If heart rate < 60 beats per minute:

Answer 12

• Ensure effective ventilations with supplementary oxygenation and adequate chest rise.
• If no improvement after 30 seconds, initiate chest compressions.
• Coordinate chest compressions with BVM ventilations.

Question 13

When do you use epi on newborns?

Answer 13

Epinephrine is indicated if the newborn?s heart rate remains less than 60 beats per minute after at least 30 seconds of positive pressure ventilation, and another 60 seconds of chest compressions coordinated with positive pressure ventilation administered with 100% FiO2.