Neonatal resuscitation skills are essential for all health care providers who are involved in the delivery of newborns. The transition from fetus to newborn requires intervention by a skilled individual or team in approximately 10% of all deliveries.

1. NEONATAL
RESUSCITATION

2. INTRODUCTION
APPROXIMATELY 10% OF TOTAL NEWBORNS
REQUIRE SOME ASSISTANCE TO BEGIN
BREATHING AT BIRTH.
LESS THAN 1% REQUIRE EXTENSIVE
RESUSCITATIVE MEASUREMENTS.
BASIC LIFE SUPPORTARE NEEDED FOR THE
BABIES WHO ARE HAVING BIRTH ASPHYXIA.

3. DEFINITION
NEONATAL RESUSCITATION IS THE SERIES OF
ACTIONS, USED TO ASSIST NEW BORN
BABIES, WHO HAVE DIFFICULTY WITH MAKING
THE PHYSIOLOGICAL TRANSITION FROM THE
INTRAUTERINE TO EXTRAUTERINE LIFE

4. GOALS

5. GOALS
THE MAIN GOALS OF NEONATAL RESUSCITATION
ARE –
1.
2.
3.
4.
TO INITIATE NORMAL BREATHING OF THE
BABY
TO MAINTAIN ADEQUATE TISSUE PERFUSION
TO RESTORE NORMAL CORE TEMPERATURE
TO MAINTAIN ADEQUATE CARDIAC OUTPUT

6. INDICATIONS

7. INDICATIONS
MAIN INDICATIONS FOR NEONATAL C.P.R. ARE –
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
PRETERM BABIES
FETAL DISTRESS
BIRTH ASPHYXIA
HYPOXIA
HYPOPERFUSION
SEVERE I.U.G.R.
GRASPING RESPIRATION
PERSISTENT CENTRAL CYANOSIS
NO CRYING
BRADYCARDIA ( H.R. < 100 beats / min )

8. EQUIPMENTS

9. EQUIPMENTS
THE ESSENTIAL EQUIPMENTS WHICH ARE
USED FOR NEONATAL RESUSCITATION ARE –
1. SUCTION EQUIPMENTS
2. BAG AND MASK EQUIPMENTS
3. INTUBATION EQUIPMENTS
4. MEDICATIONS
5. FLUID EQUIPMENTS
6. MISCELLANEOUS

10. SUCTION
EQUIPMENTS






BULB SYRINGE
SUCTION CATHETER
SUCTION TUBING
MECONIUM ASPIRATOR
SUCTION APPARATUS SYRINGE
CATHETER ( 10 mL or 20 mL )

11. BULB MECONIUM SUCTION
SYRINGE ASPIRATOR CATHETER

12. BAG AND MASK
EQUIPMENTS
 NEONATAL RESUSCTATION
BAG
 FACE MASK
 OXYGEN WITH FLOW METER &
TUBING

13. NEONATAL RESUSCITATION
BAG

14. INTUBATION
EQUIPMENTS
 LARYNGOSCOPE WITH STRAIGHT
BLADE ( 0 OR 1 )
 STYLET
 EXTRA BULB AND BATTERIES
 E.T. TUBE ( SIZES ARE 2.5, 3, 3.5. 4
mm )

15. LARYNGOSCOPE STYLET E.T.
TUBE

16. MEDICATIONS
 EPINEPHRINE
 SODIUM BICARBONATE
 DOPAMINE
 NALOXONE HYDROCHLORIDE

17. FLUID
EQUIPMENTS
 INTRAVENOUS CATHETER
 TAPE & STERILE DRESSING
MATERIAL
 DEXTROSE 10% IN WATER
 ISOTONIC SALINE
 T - CONNECTOR

18. MISCELLANEOUS
 GLOVES
 LINEN
 SHOULDER ROLL
 RADIANT WARMER
 STETHOSCOPE
 ADHESIVE TAPE
 SYNRINGES ( Sizes are 1, 2, 5, 10, 20, 50 mL )
 GAUZE
 UMBILICAL CATHETER ( 3.5 Fr, 5 Fr )
 THREE WAY STOPCOCKS
 WATCH

19. RADIANT 3 WAY UMBILICAL
WARMER STOPCOCK CATHETER

20. T
A
B
C
OF NEONATAL
RESUSCITATION

21. T STANDS FOR MAINTENANCE OF
TEMPERATURE
A STANDS FOR ESTABLISHMENT OF AN
OPEN AIRWAY
B STANDS FOR INITIATION OF
BREATHING
C STANDS FOR MAINTENANCE OF
TEMPERATURE

22. MAINTENANCE OF
TEMPERATURE
IT CAN BE DONE BY –
RECEIVING THE BABY IN A PREWARM
TOWEL
PROVISION OF HEAT SOURCES
DRYING THE BABY
REMOVING WET LINEN

23. ESTABLISHMENT OF AN OPEN
AIRWAY
IT CAN BE DONE BY –
1. PROPER POSITIONING THE INFANT
2. SUCTION THE MOUTH, NOSE. IN SOME
CASES TRACHEA TOO
3. IF NECESSARY, INSERTAN E.T. TUBE ALSO

24. INITIATION OF BREATHING
IT CAN BE DONE BY –
1. TACTILE STIMULATION
2. P.P.V. ( POSITIVE PRESSURE VENTILATION )

25. MAINTENANCE OF
CIRCULATION
IT CAN BE DONE BY –
1. CHEST COMPRESSION
2. MEDICATIONS

26. PROCEDURE

27. PROCEDURE
 INITIAL STAGE –
1.RECEIVE THE BABY IN A PREWARMED
TOWEL
2.PLACE THE BABY IN A PREHEATED
WARMER
3. POSITION THE BABY ON BACK WITH THE
NECK SLIGHTLY EXTENDED ( SNIFFING
POSITION )
4.NO HYPEREXTENSION &
UNDEREXTENSION

28. CONT…..
5. SUCTIONING OF THE MOUTH SHOULD BE
DONE FIRST, THEN NOSE TO PREVENT THE
CHANCE OF ASPIRATION OF SECRETION BY
MOUTH
6. USE MECONIUM SUCCAR IN CASE OF
MECONIUM ASPIRATION

29. CONT…..
 PROVIDING TACTILE
STIMULATION –
1. SLAPPING AND FLICKING METHOD –
a) BY SLAPPING AND FLICKING THE BABY’S
SOLE OF FEET
b) RUBBING INFANT’S BACK

30. CONT…..
2. USING FREE FLOW OXYGEN –
BY BLOWING OVER THE NEONATE’S NOSE, SO
THAT THE BABY BREATHES OXYGEN
ENRICHED AIR.
FLOW SHOULD BE 5L / Min
IF THE BABY IS HAVING SPONTANEOUS
RESPIRATION, H.R. IS ABOVE 100 BEATS PER
MINUTE WITH SKIN COLOR PINK, THEN BABY
NEEDS ONLY OBSERVATIONAND
MONITORING.

31. CONT…..
NOTE : -
IF THE BABY IS HAVING SPONTANEOUS
RESPIRATION, H.R. IS ABOVE 100
BEATS PER MINUTE WITH SKIN COLOR
PINK, THEN BABY NEEDS ONLY
OBSERVATION AND MONITORING

32. CONT…..
 BAG & MASK VENTILATION –
SHOULD BE STARTED IF AFTER TACTILE
STIMULATION –
1. THE INFANT IS STILL APNEIC OR
GRASPING
2. HAVING SPONTANEOUS RESPIRATION
BUT H.R. IS BELOW 100 BEATS PER
MIN

33. CONT…..
FOR B.M.V. –



BABY’S NECK SHOULD BE SLIGHTLY
EXTENDED TO ENSURE OPEN AIRWAY
MASK TO BE PLACED IN POSITION WHICH
SHOULD COVER TIP OF THE CHIN,
MOUTH AND NOSE
VENTILATION SHOULD BE DONE AT THE
RATE OF 40 - 60 BR. PER MIN

34. CONT…..
 FOLLOW A
‘SQUEEZE’ – ‘TWO’– ‘THREE’ – ‘SQUEEZE’
SEQUENCE.

35. CONT…..
FINDINGS INTERVENTIONS
1.
2.
3.
H.R > 100
BEATS/MIN
H.R. IS BETWEEN
60 – 100
BEATS/MIN
H.R. < 60
BEATS/MIN
1.
2.
3.
STOP B.M.V. AND
MONITOR THE BABY
ONLY
CONTINUE B.M.V.
CONTINUE WITH
CHEST
COMPRESSION

36. CONT…..
 CHEST COMPRESSION –
MUST BE PERFORMED ALONG WITH
VENTILATION AND 100% OXYGENATION
METHODS : -
IT CAN BE DONE BY TWO METHODS,
1. THUMB COMPRESSION
2. TWO FINGER TECHNIQUE

37. CONT…..
LOCATION :-
THE PRESSURE SHOULD BE APPLIED AT
THE LOWER THIRD OF THE STERNUM
DEPTH :-
THE DEPTH SHOULD BE ½ TO ¾ INCH.
RATE :-
THE RATE OF CHEST COMPRESSION WILL BE
90 COMPRESSIONS AT A MINUTE ALONG WITH
30 P.P.V.
TOTAL 120 EVENTS PER MINUTE

38. CONT…..
PATTERN :-
TWO PERSON SHOULD BE THERE
THREE COMPRESSIONS FOLLOWED BY
ONE VENTILATION
TIME DURATION :-
3 CHEST COMPRESSIONS SHOULD BE
DONE WITHIN 1.5 SECOND
1 VENTILATION SHOULD BE DONE
WITHIN 0.5 SECOND

39. CONT…..
4 EVENTS ( 3 COMPRESSIONS + 1 P.P.V. ) NEED
2 SECOND TO BE COMPLETED
THUS, WITHIN 1 MINUTE, TOTAL 120 EVENTS
SHOULD BE COMPLETED.

40. CONT…..
 E.T. INTUBATION :-
ENDOTRACHIAL INTUBATION IS
INDICATED WHEN –
1. PROLONGED VENTILATION IS
NEEDED
2. B.M.V IS INEFFECTIVE
3. TRACHEAL SUCTION IS NEEDED
4. DIAPHRAGMATIC HERNIA IS
SUSPECTED

41. CONT…..
TUBE SIZE SHOULD BE APPROPRIATE
BLADE SIZE SHOULD BE 0 OR 1

42. CONT…..
 MEDICATION :-
UMBILICAL VEIN SHOULD BE USED
FOR ADMINISTERING MEDICATION.
NO INTRACARDIAC DRUG SHOULD BE
GIVEN.
SOME OF THE MEDICATIONS CAN BE
GIVEN THROUGH E.T. TUBE.

43. CONT…..
EPINEPHRINE –
DOSE - 0.01 TO 0.03 mg/Kg
ROUTE - I.V.
SODIUM BICARBONATE –
1:1 ( WITH WATER )

44. COMPLICATIONS

45. COMPLICATIONS
 PULMONARY HYPERTENSION
 HYPOTHERMIA
 RIBS FRACTURE
 HYPOXEMIA
 PNEUMOTHORAX
 HYPOGLYCEMIA
 TACHYAPNEA
 HYPERVENTILATION
 HYPOXIC ISCHEMIC ENCEPHALOPATHY

46. NURSES
RESPONSIBILITIES

47. NURSES
RESPONSIBILITIES
 BEFORE C.P.R. –
1. KEEPALL THE EQUIPMENTS READY BY THE
TIME OF DELIVERY
2. ASSESS THE NEWBORN. CHECK H.R., TEMP,
APGAR SCORE 2 TIMES.
3. WIPE THE BABY DRYAND PLACE ON A
RADIANT WARMER
4. CHECK THE AIRWAY
5. DO SUCTIONING IF NEEDED
6. PROVIDE TACTILE STIMULATION
7. CHECK THE H.R. AGAIN

48. CONT…..
 DURING C.P.R. –
1. KEEP THE AMBUBAG READY
2. COVER THE MOUTH WITH THE MASK
PROPERLY
3. MONITOR H.R. CONTINUOUSLY
4. START CHEST COMPRESSION IF H.R.
BELOW 60 beats / min
5. DO NOT GIVE EXTRA PRESSURE WHILE
CHEST COMPRESSION
6. MONITOR VITAL SIGNS CONTINUOUSLY,
SPECIALLY THE H.R.

49. CONT…..
 AFTER C.P.R. –
1. MONITOR THE TEMP. OF THE BABY
2. MONITOR THE H.R.
3. PLACE THE BABY IN A RADIANT WARMER
4. DISCARD THE DISPOSABLE ARTICLES
5. SEND THE REUSABLE ARTICLES FOR
STERILIZATION
6. GIVE THE BABY TO THE MOTHER FOR
FEEDING
7. MAINTAIN ALL THE RECORD AND REPORT
IMMEDIATELY IF ANY COMPLICATION IS FOUND

50. REFERENCES
 DUTTA PARUL, PEDIATRIC NURSING,
JAYPEE PUBLICATION, FOURTH EDITION,
PAGE NO : 75, 76,77
 THOMAS SR. LISSY JMJ, CLINICAL
NURSING PEDIATRIC PROCEDURE
MANNUAL, PEE VEE PUBLICATION,
SECOND EDITION
 SHARMA R, ESSENTIALS OF PEDIATRIC
NURSING, JAYPEE PUBLICATION, FIRST
EDITION