Effective neonatal resuscitation at birth is vital in preventing infant mortality, necessitating comprehensive clinical guidelines tailored for resource-limited settings. The document outlines the essential equipment, procedures, and interventions needed for successful neonatal resuscitation, including temperature maintenance, suctioning, positive pressure ventilation, and chest compressions. It emphasizes the importance of skilled personnel and proper monitoring to ensure the successful stabilization of newborns at risk.

2. UNIT : III
NURSING CARE OF A
NEONATE

3. Effective resuscitation at birth can prevent
large proportion of deaths. The need for all clinical
guidelines on basic new born resuscitation suitable
for settings with limited resources it universally
recognised.

4. • Neonatal resuscitation is defined at the set of
intervention at the time of birth to support the
establishment of breathing and circulation.

5. • To restore breathing and blood circulation
• To maintain perfusion of oxygenated blood to
cells

6. • Ante natal factors
• Intranatal factors

7. • Maternal diabetes
• Maternal infection
• Hydromnias
• Post term gestation
• Maternal drug abuse like rrspiridone, lithium
carbonate

8. • Abnormal presentation
• Premature labor
• Early rupture of membrane
• Fetal bradycardia
• Cord prolapse
• Meconium stained aminiotic fluid

9. • Every birth as high risk all resuscitation arrangement and
essential to be kept ready.
• At least one health personnel should be skilled in neonatal
resuscitation, who should present at the delivery room .
• Heat Sourse should be kept ready to use.
• The resuscitation room/ area in the delivery room must be
well lighted,warm with arrangement for resuscitation.
• The essential articles must be checked by the nursing
personnel in every day shift.
• Resuscitation procedure should be performed with full

10.  Mucous aspirator
 Meconium aspirator
 Mechanical suction apparatus
 Suction catheter 10F or 12F
 Feeding tube 6 F ,10 or 20 ml syringe
• Suction equipment

11. • Neonatal resuscitation bag
• Oxygen source with flow meter
• Oxygen reservoir and tubing
• Face mask should be appropriate size for both
term and preterm
Bag and mask Equipments

12. • Neonatal laryngoscope with stright blade( no.00- 0:
for preterm,no:1 for term babies)
• Extra bulb and batteries for laryngoscope
• Entotracheal tube ( size- 2.5,3.0,3.5,4.0mm ID)
• Stylet
• scissors

13. • Epinephrine
• Naloxone hydrochloride
• Normal saline
• Ringer’ s lactatae solution
• Sodium bicarbonate
• Albumin
• Dopamine

14. • Watch with second hand
• Towel shoulder roll
• Prewarmed linen
• Radient warmer or heat
source
• Stethoscope
• Syringes(1,2,5,10,20,50
ml)Needles
• Umblical catheter
• Three way stopclocks
• Gloves
• Gauze
• Thermometer
• Scalp vein set
• Air way tube
• Sport light

15. • The components of the neonatal resuscitation
procedure are described as the acronym TABCs
of Resuscitation.
• T: Maintenance of temperature
• Provision of radiant heat source
Drying the baby
Removing wet linen

16. • Position of newborn
• Suction the mouth and nose
• If necessary insert the an
endotracheal tube to
ensure the airway

17. • Tactile stimulation to initiate
respiration
• Positive pressure ventilation
(PPV) using either bag and
mask or ET intubation

18. • Maintenance of circulation
 Stimulate and maintain the
blood circulation by chest
compression and
medication

20. • Immature lungs difficult to ventilate and also
more vulnerable to injury by PPV
• Immature blood vessels in the brain that are
prone to hemorrhage
• Thin skin and large BSA– Rapid heat loss
• Increased susceptibility to infection
• Increased risk of hypovolemic shock related to
small blood volume

21. Intial steps
• Heat source

22.  Receiving the newborn baby in a
prewarmed towel and placing the baby
on the preheated Radient warmer.
 If warmer is not available, room heater or a
bulb of 200 w can be used,which should be
fixed in a suitable places. Never allow the
baby to become hypothermic

24. • Positioning of the baby on the back with the neck
slightly extended sniffing position hyperextension or
under extension should be prevented which may
decrease air entry.
• To maintain correct position . Shoulder roll may be
useful elevating shoulder ¾ to1 inch off the matters
• If the neonate has copious secreation head should
be turned oneside

25. • Suctioning of the mouth should be done first then the
nose. Otherwise there is a change of aspirations of
secreations from mouth.

26. • Suctioning should be done carefully to prevent stimulation of
posterior pharynx which can lead to bradycardia and apnea.
• Vigoious and continuous suction to be avoided.
• Suction pressure to be kept around 80 to100 mmHg(100-130
water).
• Tracheal suctioning may be needed through endotracheal
tube in meconium stained liquor.
• Suction tube is inserted 5cm for mouth,3cm for nostrils
• Suction for less than 20 seconds

27. • Drying the baby whole body and head quickly
and removing the wet linen immediately
• The baby is then placed further on a prewarmed
towel to reduce heat loss
• Drying the baby prevent evaporate heat loss and
provide gentle stimulation which may help to
initiate respiration

28. • Tactile stimulation by slapping or flicking the sole on the
feet or rubing the newborn back once or twice to
stimulate breathing

29. • Continued use of tactile stimulation in a newborn does
not respond may be harmful and wastage of valuable
time.
• The baby is not taking respiration spontaneously may
breathe after one or two tactile stimulation only.

31. • Free flow Oxygen by over the newborn nose so
that the baby breaths Oxygen enriched air
• This can be given by using Oxygen mask or
cupped hand at the flow rate of 5 liters per
minute

33. • The newborn has no spontaneous breathing
then PPV should be starter with bag and mask
• If the baby is taking respiration spontaneously
but heart rate is below 100 beats per minute at
that condition also PPV should be started
immediately

35. • It recommended in preterm infants are breathing
spontaneously but with difficulties
• Starting newborn on CPAP decrease the rate of
intubation and mode of ventilation, surfactant
use and duration of ventilation but increase rate
of pneumothorax.

36. • Bag and mask ventilation
should be started if after
tactile stimulation

37.  The newborn is still apneic or gasping
 Having spontaneous respiration but heart rate is below 100
beats per minute.
Bag and mask ventilation, the babys neck should be slightly
extended to ensure open airway. Mask to be placed in position
and seal to be checked by 3 to 3 ventilation.
Place the mask covering tip of the chin, the mouth and nose.

38.  Rise of chest to be observed and if chest does not rise
then reapply mask , reposition baby’s head , suction if
needed and ventilate with slightly open mouth and
increased pressure.
 Ventilation should be done at the rate of 40-60 breaths
per minute. Follow a squeeze two ,three squeeze
sequence.

39. • Bag and mask ventilation should be initiated with air only. Then
Oxygen tubing from the oxygen source and the oxygen reservoir to be
attached to increase the oxygen concentration even up to 100percent
during BMV.
• After 15 to 30 seconds ventilation, the baby again should be evaluated if
the heart rate is above 100 beats per minute and spontaneous
respiration is present then provide tactile stimulation. Monitor heart rate
respiration and colour. If no breathing establishes continue ventilation.
• If heart rate is not increased with ventilation then check adequacy
of ventilation and start chest compression.

40. Two finger method

41. • Thumb method

42. • Chest compression must always be performed along with
ventilation and 100 percent oxygen. It is indicated if after 15-
30seconds of PPV with 100 percent oxygen, the heart rate is
below 60 beats per minute and not increasing.
• Chest compression or external cardiac massage is given to
increase the intrathoracic pressure and to circulate blood to
the vital organs of the body.

43. Started when HR<60 per minute despite adequate
ventilation with 100% oxygen for 30 sec
The pressure is applied to the lower third of the sternum
to depress it ½ to ¾ inches.
2 techniques:
2 thumb-encircling hands technique
Compression with 2 fingers ,second hand supporting
the back
3:1 ratio::[ 90 comp:30 ventilations]

46.  Endotracheal intubation is a specialized and skilled
procedure. It’s indicated
 Prolonged PPV is required
 Bag and mask ventilation is ineffective
 Tracheal suction is needed
 The tube should be selected and must have vocal Cord
guide
 It is cut at 13 cm and the connector to be replaced.
 Laryngoscope should be in working condition and of
appropriate size

47. • Neonates should be positioned on a flat surface
with the neck slightly extended
• The procedure is usually performed by
neonatologist or anesthesiologist or any doctor
skilled with this technique.
• Preparation of the positioning ,assisting during
the procedure are the important responsibilities
of the nursing personnel. Only small number of
neonates required ET intubation

48. Soft mask, fits over laryngeal inlet
when inflated, occludes the oesophageal
opening
Done when BMV is unsuccessful &
tracheal intubation is unsuccessful or not
feasible

51. The neonate heart rate is not increased despite adequate
ventilation with 100 % oxygen and chest compression then use
drugs to stimulate heart.
 Adrenaline(1:1000) 0.1-0.3 ml/ kg lv repeated every 3-5 minutes
 Volume expanders ( NS,RL 5/ albumin)10 ml/ kg lv 5-10 minute
 Sodium bicarbonate 2ml/kg of body weight, diluted 1:1 in distil
water
 Naloxone hydrochloride 0.1 mg/ kg lv maternal narcotics
administration with in 4hrs.
 Dopamine in Continued shock ,dose 5-20 mg/ kg/ minute
continuous

52. 1 minute 60-65%
2 minutes 65-70%
3 minutes 70-75%
4 minutes 75-80%
5 minutes 80-85%
10 minutes 85-90%

53. Asses if resuscitation is needed, keep
warm, position, clear, dry, stimulation
Give oxygen as necessary
Positive pressure
ventilation
Endotracheal
intubation
Chest
compression
drugs

54.  <30 seconds: complete initial steps
▪ Warmth
▪ Drying
▪ Clear airway if necessary
▪ Stimulate
 30-60 seconds: assess 2 vital characteristics
▪ Respiration (apnea/gasping/labored/unlabored)
▪ Heart rate (<100/>100bpm)
 Golden Minute Project: skill based training

56. • Babies are require resuscitation at risk for deterioration after
their vital signs have returned to normal
• Closely monitor the neonate until the breathing on his/ her
own
• Assist in intubating the child and connect with oxygen
source.
• Start lv infusion as prescribed
• Monitor the child continuously.

57.  Conditions with certainly early death
 Extreme prematurity(GA<23 weeks)
 Birth weight<400g
 Anencephaly
 Chromosomal abnormality:Trisomy 13

58.  High rate of survival
 Acceptable morbidity
 GA≥ 25 weeks
 Those with most congenital malformations

59.  Newborn with no detectable heart rate,
consider stopping NNR if the heart rate
remains undetectable for 10 minutes

60. • Neonatal resuscitation training in all facilities
reduces term ,intrapartum related deaths 30
percent . Expert opinion supports smaller effects of
neonatal resuscitation on preterm mortality in
facilities and basic resuscitation.

61. • Adele pillitteri (2010), Maternal and child Health Nursing,
6th edition, Lippincott Williams and Wilkins publications.
• Lowdermilk Perry (2007), Maternity and Womens Health
Care, 9th edition, Mosby Elsevier publications.
• Wong Perry, Hockenberry and Lowdermilk Wilson
(2006), Maternal Child Nursing Care, 3rd edition, Mosby
Elsevier publications.
• Emily Wone Mckineey, Sharon Smith Murray, Jeen
Weiler Ashwill (2009), Maternal Child Nursing, 3rd
edition, Saunders Elsevier publications.