This document provides guidance on newborn resuscitation. It begins by explaining why resuscitation may be necessary for some infants during birth as they transition from a fluid environment in the womb to breathing air. It then outlines the steps of newborn resuscitation including establishing the airway, assisting breathing, and circulation support. Key techniques like bag-mask ventilation, endotracheal intubation, and chest compressions are described. The goal of newborn resuscitation is to prevent hypoxia and provide adequate oxygen to the brain and vital organs.

1. BY
KAUSHIK.D.S

2.  Why is it necessary?
 When should be done?

3.  DETAILS
 HISTORY
Family history
Gestational history
Delivery details
Neonatal history

4.  GENERAL EXAMINATION
 VITALS
 APGAR score
 ANTHROPOMETRY
 HEAD TO FOOT EXAMINATION
 NEONATAL REFLEXES

5. Colour :- Pink, cyanosis, pallor
Appearance of skin :- Vernix, Lanugo hair
Activity :- Normal or diminished
Tremulous movements

6.  Temperature (36.6-37 degree centigrade)
 Respiratory rate (30-50 breaths/minute)
 Heart rate (100-160beats/minute)
 Capillary filling time (less then 3seconds)

7. score 0 1 2
A-Appearance
(colour)
Pale or Blue Body pink
Periphery blue
Pink throughout
P-Pulse Absent <100/minute >100/minute
G-Grimace
(response to
suction)
Absent Facial grimace Coughing/crying
A-Activity
(muscle tone)
Flaccid Some flexion of
limbs
Good activity
R-Respiration Absent Weak,
Gasping,
Irregular
Regular
respiration,
Crying lustily

8.  Weight (2.7-2.9kg)
 Length (50 cm)
 Head circumference(35cm)
 Chest circumference(1.25-2.5cm less than HC)
 Upper segment to lower segment ratio (7:1)

10. Face
Skull
Eyes
Ear deformities
Mouth
Nose
Neck
Skin
Chest
Umbilical cord
Genitalia
Anus
Limbs
Spine
Hip

11. oAnterior and posterior fontanelles
oMolding
oCaput succedaneum
oCephalhematoma

21. Chest
 Chest deformities
 Breathing
 Heart :- location, heart rate, peripheral pulses

24. Abdomen
 Shape, distension
 Organomegaly
 Unusual masses

28.  Congenital hip dislocation ( Ortolani & Barlow
Maneuvers)
◦ Assymetry of the skin folds on the dorsal surface
◦ Shortening of the affected leg

30.  Moro reflex
 Palmer grasp
 Suckling and rooting reflexes
 Tonic neck response

35. Final impression should be recorded
as
Gestational age classification
Gestational age in weeks
Diagnosis
E.g: small for gestational age, 34
weeks, chromosomal anomaly.

36.  INTRODUCTION
 the process of birth brings the fetus from a
fluid environment to an air environment.
 This transition is accompanied by
physiological and biochemical changes.
 Most infants adapt to changes successfully
and do not require any intervention,4-6% of
them require resuscitation

37. Preterm
27%
Sepsis &
pneumonia
26%
Asphyxia
23%
Congenital
7%
Tetanus
7%
Diarrhoea
3%
Others
7%

38.  Fetal lungs are filled with lung fluid that is
derived from amniotic fluid that the fetus
inhales regularly.
 This fluid is expelled from the lung as the
fetus is squeezed through the birth canal, the
rest is expelled by initial breaths.

39.  CONDITION AFFECTING MOTHER
 OBSTETRIC COMPLICATION
 FETAL FACTORS
 MALFORMATIONS OF RESPIRATORY TRACT AND
LUNG
 INFANTS DELEVERED FOLLOWING
INSTRUMENTATION

40.  Most infants have apgar score between 7/10
to 10/10 at one minute and do not require
resuscitation .
 Infants with apgar score 4-6 require some
intervention while those with <3/10 are
severly compromised and warrant urgent
resuscitation.

41.  The primary goal is to provide adequate
oxygen to the vital organs particularly the
brain, preventing hypoxia and its
consequence.
 The general principles of resuscitation
A : Air way
B :Breathing
C :circulation
D :Drugs

42.  INVERTED PYRAMID OF NEONATAL
RESUSCUTATION

47.  Place an appropriate size face mask
 Hold the face mask between the index finger and thumb of
the left hand, with the middle finger supporting the jaw.
 Extend the neck of the baby slightly and lift the jaw
forwards.
 Manually compress the bag at a rate of 40-60/min ,using
air or air-oxygen mixture at a flow rate of
5-10/min
 Ensure good chest expansions in order to provide adequate
ventilation

48.  If bag mask ventilation last for >2min
aspirate air from stomach at the end of
procedure to prevent gaseous abdominal
distention.
 If the baby does not improve with bag mask
ventilation in 30seconds, proceed to
endotracheal intubation.

50.  Put the baby flat or with the head slightly tilted
downwards and suck out the fluid from oropharynx
 Extend the neck of the baby slightly
 Introduce an appropriate size laryngoscope with
straight blade
 Advance the blade to the vallecula and lift the
tongue forward, exposing the epiglottis and
laryngeal opening.

51.  Introduce an appropriate size ETT into the
trachea, past the vocal chords, to the depth of 2-
2.5cm to avoid selective intubation of the right
main bronchus.
 Hold the ETT at that position or tape it to the
angle of the mouth.
 Connect the ETT to the resuscitation bag and
apply positive pressure ventilation at the rate of
30/min and Fio2, pressure of 20-25 cm of water.
 Auscultate the chest and stomach to confirm the
position of the tip pf the ETT.

53.  Stand by the side or feet of the baby
 Encircle the infant’s chest with both hands such that the
fingers support the back of the chest and the two thumbs
placed over the lower third of the sternum.
 Compress the chest to the depth of onethird the
anteroposterior diameter of the chest . This can also be
carried out with 2 finger compressing the lower sternum.
 The ratio of ECM to lung inflation is 3:1 , 90chest
compression and 30 breaths in 1min.
 Give adrenalin if the heart rate remains less than 60/min
despite 30 seconds of intermittent positive pressure
ventilation and ECM

54.  When the asphyxiated infant do not respond to resuscitation ,
check for technical errors
 Oxygen source, tubing and connecting points.
 Bag may not deliver enough pressure to inflate the lungs
adequately.
 Endotracheal tube(ETT) has been dislodged or esophageal
intubation has occurred, reintubate the baby.
 Endotracheal tube may be blocked(by blood clot or mucus) in
which case the airway resistance is high. Either lavage the tube or
change the ETT
 Endotracheal tube is in the right main bronchus. Air entry will be
diminished on the left, withdraw the ETT slightly until the air
entry is equal.

55.  Doing the simple things better is probably
the most cost-effective policy.
 Resuscitation can come as complete surprise
So be prepared for resuscitation.
 It may take several hours to learn but it
should be implemented over seconds.
 Practice makes one perfect.