Neonatal resuscitation is performed to help newborns breathe and for their hearts to beat properly after birth. It is essential for healthcare providers assisting with deliveries. Guidelines from the AHA and AAP are used worldwide in the NRP. Supplies and equipment needed for resuscitation include suction, bag and mask ventilation, intubation equipment, medications, and other miscellaneous items. Assessment of the newborn's breathing, heart rate, tone and color determine if further intervention is needed. Steps may include warming, clearing the airway, stimulation, supplemental oxygen or positive pressure ventilation, chest compressions, and intubation with medications in some cases.

1. Dr Anagha Anand

2.  Neonatal Resuscitation is intervention after a
baby is born to help it breathe and to help its
heart beat.
 Of the 25 million infants born every year in
India, 3-5% experience asphyxia at birth
 Neonatal resuscitation skills are essential for
all health care providers who are involved in
the delivery of newborns

3.  The American Heart Association (AHA) and
the American Academy of Pediatrics (AAP)
have updated the resuscitation guidelines
that are being propagated world wide
through the NEONATAL RESUSCITATION
PROGRAM (NRP)

4.  Anticipation
 A radiant heat source ready for use
 All resuscitation equipments immediately
available & in working order
 At least 1 person skilled in neonatal
resuscitation

7. Neonatal Resuscitation Supplies & Equipments
-Suction Equipment
Mechanical suction
Suction catheters 10,12, or 14 F
Meconium aspirator
-Bag and Mask Equipment
Neonatal resuscitation bags ( self limiting)
Face-masks ( for both term & preterm babies)
Oxygen with flow meter and tubing
-Intubation Equipment
Laryngoscope with straight blades no.0 (preterm)& no.1 (term)
Extra bulbs & batteries ( for laryngoscope)
Endotracheal tubes ( int diameter 2.5, 3, 3.5 & 4)

8. Medications
Epinephrine
Normal saline or Ringer Lactate
Naloxone hydrochloride
Miscellaneous
Linen, shoulder roll, gauze
Radiant warmer
Stethoscope
Syringes 1,2,5,10,20,50 ml
Feeding tube 6 F
Umbilical catheters 3.5, 5 F
Three way stopcocks
Gloves

9.  Based primarily on 3 signs
 Respiration
 Heart rate
 Color

11.  Performed at 1min & again at 5 min after birth.
 But resuscitation must be initiated bfr 1 min score
is assigned
 Not used to guide resuscitation
 But can reflect how well the baby is responding to
resuscitative efforts
 Should be obtained every 5 min for upto 20 min,
if the score is < 7

13. Term / Preterm ?
 Term: smooth transition
 Preterm : stiff, under-developed lungs,
insufficient muscle strength, can’t maintain
temperature
Breathing/Crying ?
 Watch baby’s chest
 Gasping is a series of deep, single or stacked
inspirations that occur presence of
hypoxia/ischemia. Treated as apnea.

14. Good tone ?
 Term: flexed extremities
 Preterm/sick: flaccid/limp,
extended extremities

15.  Provide warmth : Radiant warmer, don’t cover with
blankets or towels.
 Position head and clear airway if necessary
 Placed on her back or side with neck slightly
extended.
 Brings post pharynx, larynx & trachea in line
 Place a rolled blanket or towel under the shoulders,
elevating them 3/4th or 1 inch off the mattress.

17.  Suction mouth first, then nose
 “M” before “N”
 To prevent aspiration of mouth contents
 If copious secretions present → head should
be turned to one side
 Never insert catheter too deep in mouth or
nose for suction → stimulation of post
pharynx → vagal response → bradycardia or
apnea
 Max time limit – 15 sec

19.  For non-vigorous babies initial steps are
modified as:
 Place under radiant warmer. Postpone drying &
suctioning to prevent stimulation
 Remove residual meconium in the mouth & post
pharynx by suctioning under direct vision using
laryngoscope
 Intubate & suction out meconium from the lower
airway

20.  Dry, Stimulate and Reposition
 Stimulate : Flicking the soles/ drying & rubbing
the back

21.  Respirations
 Heart rate: Best is auscultation, alternatively
pulsations at base of cord is felt. Count for 6s and
“x”10
 Color- look at tongue, mucous membranes & trunk

22.  If baby has good breathing, HR>100/min, no
cyanosis →no additional intervention
 If baby has laboured breathing or persistent
cyanosis
-preterm babies → CPAP
-term babies→ supplemental oxygen
 If baby is apneic, has gasping breathing or HR <
100/min → PPV is needed

23.  PPV – using a self-inflating bag & face mask

24. Indications:
 Gasping/apnea
 HR < 100/min
 Persistent central cyanosis despite
administration of 100% free flow oxygen
Contraindications:
 Diaphragmatic hernia
 Non vigorous babies born through MSL, B & M
ventilation carried out only after tracheal
suctioning

25. Appropriate Sizes
Mask should
Rest on Chin
Cover Mouth
& Nose

26. When n/l rise of chest is observed start ventilating.
Ventilation should be carried out at a rate of 40-60
breaths per min, following a ‘squeeze, two, three’
sequence

27.  PPV may cause abd distension as gas escapes
into the stomach via oesophagus.
↓
Presses on diaphragm & compromises the
ventilation
 So orogastric tube should be inserted & left
open to decompress the abdomen

28. Rhythmic compression of the sternum
→compress heart against spine → ↑se
intrathoracic pressure → circulate blood to
the vital organs
 Always accompanied by BMV so that only
oxygenated blood is circulated

29. Indications :
 HR <60/min even after 30 sec of effective
PPV
 Once HR>60/min CC should be discontinued.

30.  Thumb technique: 2
thumbs depress the
sternum, hands encircle
the torso and the fingers
support the spine.
Preferred technique
 2 – Finger technique:
Tips of middle &
index/ring finger of one
hand compresses
sternum, other hand
supports the back.

31.  A positive breath should follow every third
chest compression
 In 1 min 90 compressions & 30 breaths are
administered
 To determine the efficiency of CC, the carotid
or femoral pulsations should be checked
periodically

32.  After 30 sec HR is checked:
 HR<60 → CC should continue along with B &
M ventilation. In addition medications have to
be given
 HR>60 → CC should be discontinued. BMV
should be continued until the HR > 100/min
& the infant is breathing spontaneously

34.  When tracheal suction is required ( non
vigorous babies born through MSL)
 When prolonged BMV is required
 When BMV is ineffective
 When diaphragmatic hernia is suspected

35.  Laryngoscope with extra blades and bulbs
 Straight blades
 Term – 1
 Preterm – 0

37.  Infant’s head should be in midline & neck
slightly hyper extended.
 Laryngoscope is held in left hand b/w thumb
& the first three fingers, with the blade
pointing away from oneself
 Stand at the head end, the blade is
introduced in the mouth & advanced to just
beyond the base of tongue

39.  Once the glottis & vocal cords are visualized,
he ET is introduced from the right side of the
mouth
 Its tip is inserted into the glottis until the
vocal cord guide is at level of the glottis

40. 1. Epinephrine (1:1000)
Indication :HR< 60/min after 30 sec of effective
PPV & CC.
Effects: Inotropic, chronotropic, peripheral
vasoconstrictor
Dose: 0.1-0.3ml/kg
Route: i.v, through umbilical vein, directly into
tracheobronchial tree through ET

41.  NS, RL
Indication: Acute bleeding with hypovolemia
Effects: increase intravascular volume, improves
perfusion
Dose: 10ml/kg
Route: umbilical vein

42.  Naloxone (0.4mg/ml)
Indication: Respiratory depression with maternal
history of narcotic use within 4 hr of birth
Effects: Narcotic antagonist
Dose: 0.25ml/kg(0.1mg/kg)
Route: i.v preferred, delayed onset of action with
i.m use, administer only after restoring ventilation