2. Learning objectives
To assess a newborn baby at birth
To perform basic resuscitation of a newborn
baby using standard equipment
Resuscitation in special situations: meconium
stained liquor and preterm birth
To learn principles of aftercare for a baby who
requires resuscitation at birth
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3. Preparing for birth
Wash your hands
Draught free, warm room - temperature >250C
Clean, dry and warm delivery surface
Radiant heater
Two clean, warm towels/clothes
A folded piece of cloth
Self inflating bag - newborn size
Infant masks in two sizes - normal and small newborn
Suction device
Oxygen (if available)
Clock
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Check if all equipments are in working order
4. Assessment at birth
Deliver the baby on to mother’s abdomen
Note and record time of birth
Thoroughly dry the baby
Use a warm towel
Discard wet towel after drying
Wrap the baby in another warm cloth
Keep the baby warm
Assess breathing while drying
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5. Care of the baby at birth
Assess breathing:
Assessment Decision
Baby is crying No need for resuscitation or
suctioning;
Start skin-to-skin contact and
breastfeeding
Baby is not crying, but breathing
at 30 to 60 times per minute
No need for resuscitation or
suctioning
Baby is gasping Start resuscitation immediately
Baby is not breathing Start resuscitation immediately
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6. Scenario 1
A mother arrived at your maternity hospital and
delivered a baby girl as soon as she reached the
labor ward. The placenta followed the baby and
mother was not bleeding.
The baby was pale. He was breathing and heart
rate was 120/min.
What is the Action?
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9. Message 1
ONLY Routine care is required for a baby who is
crying or breathing normally;
Even routine suctioning is not required for these
normal babies
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10. Scenario 2
A baby girl is born at your clinic after second stage of
60 minutes. The umbilical cord is short.
You see that the skin is pale .She is not breathing.
Heart rate is over 100/min.
What is the Action?
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11. Steps of resuscitation
If the baby is not breathing or gasping
Call for help!
Cut cord quickly, transfer to a firm, warm
surface [under a radiant heater]
Inform the mother that baby has difficulty
breathing and you will help the baby to breathe
Start newborn resuscitation
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18. Selecting Bag & Mask
equipment
Size of bag: 240-750 ml
Oxygen capability: Oxygen
source, reservoir
Safety feature: Pop off valve,
pressure gauge (optional)
Ventilate (if still not breathing)
Steps of resuscitation
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19. Use the CORRECT size face
mask that covers:
The nose
The mouth
The tip of the chin
but not the eyes
Ventilate
Steps of resuscitation
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20. Fitting a face mask:
A face mask that is too LARGE
Covers the eyes
Extends over the tip of the chin
A face mask that is too SMALL
Does not cover the nose
Does not cover the mouth effectively
Steps of resuscitation
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21. Squeeze bag with 2 fingers or whole
hand, 2-3 times
Observe for rise of chest
IF CHEST IS NOT RISING:
Check seal
Reposition the head
Squeeze harder
Once good seal and chest rising,
ventilate at 40 squeezes per minute
Observe chest rise
Check heart rate after 30 seconds
Steps of resuscitation
Ventilate
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22. Message 2
Bag and mask ventilation is required for a baby
NOT BREATHING or GASPING
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23. If baby is crying;
If breathing >30/min, and
NO chest in-drawing:
If the skin between the ribs is
‘sucked’ inwards and the ribs
are prominent, the baby has
chest ‘in-drawing’
Steps of resuscitation
When to stop ventilating?
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24. Put the baby in skin-to-skin contact on mother’s
chest
Monitor every 15 minutes for breathing and
warmth
Tell the mother the baby will probably be well
Encourage the mother to start breastfeeding as
soon as possible
NEVER leave the baby alone
Steps of resuscitation
After stopping ventilation
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25. If the baby
is breathing at a rate of <30/min,
is gasping
has severe chest in-drawing
Arrange for immediate referral
Steps of resuscitation
When to continue ventilating?
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26. Explain to the mother what happened, that her
baby needs help with breathing
Ventilate during the referral
Record the event on a referral form and labour
record
If the baby is NOT breathing even after 20 minutes,
STOP ventilating
Steps of resuscitation
Referral
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27. Scenario 3
Baby girl born at 38 weeks following thick
meconium stained amniotic fluid is noted
to be limp and not breathing .
The baby is blue. She was not breathing and heart
rate was 80/min.
What is the Action?
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28. No need for intrapartum suction
Birth: assess
HR, breathing and tone
Vigorous: HR>100
good breathing
Good tone
Nonvigorous: any
parameter abnormal
Initial steps Tracheal suction
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29. Message 3
Meconium stained depressed baby needs
endotracheal suction prior to B&MV
Routine suction of oro-pharynx is not
recommended before delivery of shoulder
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30. Scenario 4
Mother admitted in maternity unit delivered a
baby boy at 32 week gestation on bed. The
baby is limp and not breathing.
The baby is pale. He is not breathing and HR is
80/min.
What is the Action?
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31. Be gentle
Use small size resuscitation bag and give small tidal
volumes to move chest
Avoid 100% oxygen , use blenders and oxygen
saturation monitors
Avoid rapid fluid bolus
May need intubation, chest compression, medications
Keep CPAP back up ready
Steps of resuscitation
Special considerations for preterm
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33. Post resuscitation management
Principles
1. Keeping normal temperature
2. Maintaining oxygenation
3. Maintaining physiological milieu- fluids , glucose
4. Maintaining perfusion
5. Treating seizures
6. Monitoring organ function
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34. Care after resuscitation
Place baby in skin-to-skin contact with mother
Keep the baby warm
Monitor every 15 minutes
Start breastfeeding as soon as possible
Discuss what has happened with the parents - be
positive!
Do not separate the mother and baby unless the baby
has difficult breathing
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35. Summary: Steps of resuscitation
1. Keep the baby warm: Place under the radiant
heater
2. Open the airway:
- Position baby’s head so it is slightly extended
- Suction the mouth and then the nose
3. If still not breathing: VENTILATE
4. If breathing or crying begins: STOP
VENTILATION
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36. Summary: Steps of resuscitation
5. If breathing at <30 breaths per minute or there
is severe chest in-drawing: CONTINUE
VENTILATION
6. If no breathing or gasping after 20 minutes of
ventilation: STOP VENTILATION
7. Explain events to the mother and document
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