The document outlines the protocols and considerations of neonatal resuscitation as detailed in the 8th edition of the textbook by the American Academy of Pediatrics and American Heart Association. Key points include the importance of pre-birth preparation, ventilation techniques, administration of medications like epinephrine, and post-resuscitation care, emphasizing close monitoring and individualized assessment. Recommendations for umbilical cord management and the significance of timely interventions are highlighted throughout.

1. Neonatal Resuscitation Program
8th edition
Dr. Renold S. Xavier

2. Why?
• Most newborns make the transition to extrauterine
life without intervention
• 5% of term NB- PPV
• 2% of term NB- intubated
• 1 to 3 per 1000 births- CC or emergency medications

4. Preparing for resuscitation
Team and equipment preparation: the “brief”
4 pre-birth questions
Expected gestational age
Is the AF clear ?
Any additional risk factors?
Umbilical cord management plan

7. Timing of umbilical cord clamping
• DCC for 30-60 s is reasonable for both term and
preterm infants who do not require resuscitation at
birth.

8. Increased venous
return to the right
atrium enters PFO
and aorta
Umbilical cord
milking
Pulmonary
vasoconstriction
Lack of cerebral autoregulation and
right to left ductal shunt result in
fluctuations in flow to an immature
brain with fragile germinal matrix.
IVH
Hemodynamic Changes During Cord Milking

9. The “Golden minute”
Textbook of Neonatal Resuscitation, 8th Ed. By American Academy of Pediatrics and American
Heart Association. Edited by Gary M. Weiner and Jeanette Zaichkin

10. Routine care

11. Sniffing the morning air position

13. Ventilation is key
• MR.SOPA if no ↑ HR/no
chest movement after
15 secs
• If HR low despite
ventilation, alternate
airway and 30 secs PPV
• Saturation targets
unchanged

14. Ventilation of the newborn's lungs is
the single most important and
effective step in neonatal resuscitation

16. 40 to 60 breaths per minute
Breathe, two, three; breathe, two,
three; breathe, two, three

17. lnitial Settings for Positive-
Pressure Ventilation

18. MR. SOPA

19. lnitial Settings for Positive-
Pressure Ventilation

20. Endotracheal intubation

21. Endotracheal intubation

22. Chest compressions
• 30 seconds PPV via AA
• 90 compressions per minute
and the breathing rate is 30
breaths per minute
• One-and-Two and-Three-
and-Breathe-and ....
• 100% FiO2
• 60 seconds- reassess
Textbook of Neonatal Resuscitation, 8th Ed. By American Academy of Pediatrics and American
Heart Association. Edited by Gary M. Weiner and Jeanette Zaichkin

24. CARDIO

25. MEDICATIONS
• Epinephrine IV/IO dose range 0.01-0.03mg/kg
• Suggested initial IV/IO =0.02mg/kg.
• Suggested initial ET dose =0.1mg/kg ( no max. dose)
• Flush with 3 ml normal saline
• Can repeat every 3-5 mins: “consider ↑subsequent
doses”
• Consider pneumothorax/hypovolemia

27. Volume expansion recommendations
a. Solution: Normal saline (NS) or type O Rh-negative
blood
b. Route: Intravenous or intraosseous
c. Preparation: 30- to 60-mL syringe (labeled NS or O-
blood)
d. Dose: 1O mL/kg
e. Rate: Over 5 to 1O minutes

28. Normal saline remains crystalloid expander of choice
Packed cells in cases of suspected fetal anemia
“Reasonable time frame for considering cessation of
resuscitation efforts is around 20 minutes after birth”….
“individualized based on patient and contextual
factors”

29. A baby who required resuscitation must have close monitoring and
frequent assessment of respiratory effort, oxygenation, blood
pressure, blood glucose, electrolytes, urine output, neurologic status,
and temperature during the immediate neonatal period.
Be careful to avoid overheating the baby during or after
resuscitation.
If indicated, therapeutic hypothermia must be initiated promptly;
therefore, every birth unit should have a system for identifying
potential candidates and contacting appropriate resources.
POST RESUSCITATION CARE

31. Thank you