2. Neonatal Resuscitation
• It is required in labour room to help new born to make resp. and circulatory transition
effectively and rapidly.
• On av. new born gasp after 6sec and majority by 20sec
• With these efforts the lungs rapidly fill with air and residual lung volume is formed. Majority
are breathing independently on avg. of 30-90 seconds. As lungs expand and filled with the
air the pulmonary blood flow increases and pressure in left atrium rises closing the foramen
ovale. As a consequence, ductus arteriosus closes and independent circulation establishes
by cessation of right to left shunting.
• Infants in utero or at birth may be asphyxiated making neonatal transition difficult and
requires resuscitation
3. cont.
• Normal breathing 40-60 b/min and HR >100
• If asphyxia occurs resp.movements and heart rate begins to fall and infant
enters in period of apnea called primary apnea,stimulaion and exposure to
oxygen will induce respiration.
• If asphyxia continues infants develop gasping respiration heart rate continues
to fall and BP also continue begins to fall,respiration becomes weaker and
irregular and infants enters in period of secondary respiration,it requies
positive pressure vent.and are at risk of brain damage
4. Preparation for Resuscitation
• Identify Helper
• Prepare area for delivery
• Wash hands
• Prepare an area for ventialtion and check equipments
5. Equipments Required
• Resuscitation table
• sterile linen
• Suction apparatus(Suction catheter,Rubber/Silicon bulb
mucous extractor)
• Ambu bag and face masks(New born and premature sizes)
• ET(various sizes),stylet,scissos,gloves
• Two pieces of cloth(one to dry the baby,one to cover)
• A cap to cover the baby’s head
• Clock or stop watch
9. Steps of Resuscitation
• First evaluate the infant,decide then take appropriate action.
• APGAR score is not used to initiate the resuscitation but for assessing the
effectiveness of resuscitation.
• Evaluation is primary based on three signs:
1.Respiration
2.Heart Rate
3.Color
Initial Steps and ABCs of Resuscitation are:
10. Steps of Resuscitation
• PREVENT HEAT LOSS:
~Dry thoroughly
~keep the resuscitation room temp above 25C
~If baby needs active resuscitation do it with radiant
warmer, if not then Mother’s chest is enough.
• Open the Airway(A)
~Position the infant to keep airway open
~Suction of mouth and nose before ambu bagging(If compromied breathing) and sometimes
of trachea in case of meconium stained liquor
• Chest physical therapy and postural drainage done every 30 min for 2 hrs and hourly
thereafter for the next 6 hrs may help remove residual meconium from the lung.
• All neonates born after meconium aspiration should be observed for 24 hrs because they
can develop Persistent Fetal Circulation syndrome.
11. cont.
• INITIATE BREATHING(B)
~Use tactile stimulation to stimulate respiration
~Employ positive pressure ventilation when necessary
using bag and mask
• MAINTAIN CIRCULATION(C):
~Stimulate and maintain the circulation of blood with chest
compressions and medications
12. Decisions and Actions
• Positioning,Suction and stimulation are necessary in
every infant at birth
• Further steps in resuscitation depend upon evaluation of
the infant on the basis of vital signs(Respiratory
effort,heart rate and color)
13. Respiratory effort:
• After stimulating the infant, main question to ask is “Does
the infant show respiratory effort?”
• if Yes! Breathing is there – if adequate chest
movements, then check heart rate.
• if NO! there is no breathing ( apnea)- baby should be
given PPV using bag and mask. Ventilation rate should be
40/minute and pressure required for initial breaths is 30-
40cm H2O and subsequent breaths require pressure of
15-20cm H2O.
• Continue ventilation for 15-30 minutes.
15. COLOR:
• When the infants respiration and heart rate improve significantly, skin also
begins to turn pink. This improvement in color is due to increased oxygen
entering the blood.
• If central cyanosis is present in an infant with spontaneous respiration and an
adequate heart rate, free flow oxygen should be given. Oxygen is not needed
for a baby with peripheral cyanosis, which may be due to combination of a
cool delivery room and initially a sluggish circulation.
• Discontinue resuscitation if there is no respiratory activity or heart is inaudible
and pupils are dilated and fixed after 20 minutes of resuscitation.
