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2. TERMS:
 Neonatal Period:
 Birth --> 28 days of life
 Term Infant:
 38 - 42 weeks of gestation
 Transition Period: Phases of instability during the
first 6-8 hours after birth

3. Viability
 Capacity to live outside of the uterus - about 22 to 24
weeks since the last menstrual period, or fetal weight
greater than 500 g.
 In the past was 28 weeks - with technology and
advancements this is becoming shorter and shorter…...

4. Sustained (2 second) Inflation Breaths
First
Breaths
Arterioles Dilate and Blood
Flow Increases
Third
Second
Fetal Lung
Fluid
Air
O2
O2 O2

5. Equipment Needed
 Overhead radiant warmer
 Bulb syringe
 BVM with heated &
humidified O2
 De Lee suction device
 Size 5 Fr suction catheters
and wall suction
 Laryngoscope with proper
sized blades
 Proper sized ET tubes
 Crash cart/Drug box

6. Normal Delivery Procedures
 Place under warmer and
towel dry
 Use bulb syringe to clear
mouth, than nose
 Tactile stimulation if not
breathing yet
 Auscultate heart and lungs
& assess color
 Prophylactic silver nitrate
or erythromycin drops in
eyes
 Vitamin K injection
 Examine umbilical cord
 Free flow O2 as needed

7. Free Flow O2
Hold O2 connecting tubing ½ inch from infants face.
Run flow at 5 LPM

8. Resuscitation
 Maternal causes:
 Drugs
 Cardiopulmonary
problems
 Infection
 Dystocia
 Utero-Placental
problems
 Fetal Causes
 Cord compression
 Prematurity
 Congenital anomalies
 Multiple pregnancy
 Meconium aspiration
 Hypothermia
 shock

9. NRP Resuscitation Algorithm

10. • Dry & cover the baby
• Assess the situation
• Airway
• Breathing - Inflation breaths
• Chest compressions
• (Drugs)
Basic steps in resuscitation

11. Initial actions
• Start the clock
• Dry the baby
• Assess
Do you need help ?

12. Initial assessment
• Colour
• Tone
• Breathing
• Heart rate

13. Condition – Group 1
• Blue Pink
• Good tone
• Breathing regularly
• Fast heart rate

14. Dry and cover
Give to Mum
• Blue Pink
• Good tone
• Breathing regularly
• Fast heart rate
Manageme
nt

15. • Blue
• Moderate tone
• Breathing inadequately
• Slow heart rate
Condition – Group 2

16. • Blue
• Moderate tone
• Breathing
inadequately
• Slow heart rate
Management
Dry and cover
Open the airway
Inflation breaths

17. • Blue or white
• ‘Floppy’
• Not breathing
• Slow or very slow heart rate
Condition – Group 3

18. • Blue or white
• ‘Floppy’
• Not breathing
• Slow or very slow heart rate
Management
Dry and cover
Open the airway
Inflation breaths
Re-assess
Do you need help ?

19. ‘Jaw thrust’ applied – in neutral position

20. • Open the airway - place the child in
the
neutral position
• If necessary, provide jaw thrust
• Give FIVE initial inflation breaths
Airway Management

21. Inflation breaths
Five breaths,
each sustained for 2-3 seconds
at 30 cms of water pressure

22. • The heart rate will usually respond
to
lung inflation
• If there is no heart rate response
check
for chest movement
Inflation breaths

23. • If the chest is not moving, it is not
being
inflated
• Check A & B
• Do not start chest compressions
until the
chest is being inflated
Chest compressions

24. Reassess
• If the heart rate is slow and not improving
• Consider chest compressions

25. Chest (cardiac) compressions
 Indicated when HR < 60bpm after 30 seconds of effective
ventilation
 3:1 compressions:breaths at HR approx 100bpm (Note:
EFFECTIVENESS IS MORE IMPORTANT THAN
RATE!!!)
 Re-evaluate HR every 30 seconds
 Continue cardiac compressions until HR rising and
approx 100bpm (Note: HR USUALLY RESPONDS
RAPIDLY)

26. Chest (cardiac) compressions
You only need to move oxygenated blood
from the lungs to the coronary arteries
Its not that far and won’t take long!

27. Reassess
• Has the heart rate improved ?
No
• Re-check airway
• Check chest movement
• Check compressions

28. • Preterm babies
 care with inflation pressures
• Meconium
 see next slide
• Congenital abnormality
 eg diaphragmatic hernia - may make
resuscitation extremely difficult
• Delivery outside labour ward
 cold babies are more difficult to resuscitate
Special Cases

29. Meconium
 Suction ONLY IF ‘SOLID’ MECONIUM causing physical
block to ventilation
 use catheter or endotracheal tube with wall suction
 Vigorous infant
 tracheal suction NOT indicated
 Infant with absent/depressed respirations, HR < 100bpm
or poor tone
 if bag ventilation is inadequate, intubate with 10F
catheter to clear SOLID meconium below cords

30. • Dry & cover the baby
• Assess the situation
• Airway
• Breathing - Inflation breaths
• Chest compressions
• (Drugs)
summary neonatal resuscitation

31. Meconium Baby
 Airway is aggressively
cleared prior to drying if
infant is meconium
stained AND baby is NOT
vigorous!
 Use ET tube as a suction
device
 May need PD & P after
heart rate, respirations,
and color stabilize
 If baby is meconium
stained but vigorous,
proceed with normal
resuscitation

32. BVM Devices

33. Bagging Technique
 Place infant in
“sniffing” position by
placing a small towel
under the shoulders
 Do not hyperextend
neck!

34. Bagging technique (cont.)
 Apply correctly sized
mask over infants
mouth and nose with
apex of mask over
bridge of nose

35. Neonatal Chest Compressions
 Asystole or bradycardia less than 60 that is not increasing
with airway and ventilation
 Use thumbs on lower half of sternum (one finger’s width
below nipple line)
 Compress ½ to ¾ of an inch, 120 times per minute
 Compression ventilation ratio is 3:1 (pause to give breath)