Resuscitation Of Neonates

Question 1

Infant breathing, crying, good tone

Management?

Answer 1

Routine care: warm, dry, delay cord clamping 1–3 min, observe

Vigorous term babies may be warmed skin-to-skin with mother.
Stimulate nonvigorous babies after drying by rubbing back
vigorously several times.

Question 2

Poor tone/respiratory effort or respiratory distress

Management?

Answer 2

Warm, open airway and clear nose and mouth (only if obstructed), dry, stimulate

Stimulate nonvigorous babies after drying by rubbing back
vigorously several times.

Question 3

Labored breathing or persistent cyanosis with HR >100 beats/min

Answer 3

Clear the nose and mouth, monitor O2 saturation; provide O2 only to maintain levels in Table 108-3. Consider CPAP.

Oxygen monitor should be placed on right upper extremity (preductal).

Question 4

Apnea, gasping, or HR <100 beats/min

Answer 4

PPV
Continue PPV for 30 s, taking corrective steps for ventilation if no improvement in HR

Provide PPV with bag-mask ventilation at a rate of 40–60 breaths/min using room air.
Provide 30 cm H2O pressure for term infants and 20–25 cm H2O pressure for preterm infants.

Question 5

HR <60 beats/min

Answer 5

Initiate CPR: 3:1 compression-to-ventilation ratio
90:30 compressions and ventilations per minute

Use thumb-encircling technique to provide chest compressions to lower one third of sternum.
Consider intubation prior to chest compressions.

Question 6

HR <60 beats/min after appropriate ventilation and CPR

Answer 6

Administer epinephrine
Consider volume expansion if blood loss; treat hypoglycemia

May be given IO, IV, or through a UV or ETT.