This document provides an overview of newborn resuscitation for EMS personnel. It discusses the physiology of transition from fetal to newborn life, initial care of the newborn including maintaining airway and temperature control, and assessment of respiration, heart rate and color. It describes providing positive pressure ventilation and chest compressions if needed. Medications like epinephrine may be administered through the umbilical vein. Specific conditions that could require resuscitation are reviewed. The key is providing minimal intervention as most newborns will respond to ventilation and warming, with chest compressions and epinephrine rarely needed.

1. EMS
Resuscitation of the
Newborn
Jim Morgan , D.O. FAAEM
Emergency Medicine
EMS Medical Director
Joplin, MO

2. Epidemiology

10% of newborns will require “assistance”
when they’re born

Incidence of complications increase as
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Birth weight decreases
Prenatal problems increase
Prenatal age decreases
Look for antepartum & intrapartum issues

3. Physiology

Prior to delivery, newborn lungs filled with
fluid

Capillaries & arterioles of lungs are
closed

Blood pumped by heart bypasses lungs
thru ductus arteriosis

4. Ductus Arteriosis

5. Physiology

During delivery (or shortly after), the
newborn begins using lungs

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Compression of chest removes fluid
Sudden inspiration causes air movement to
displace fluid
Resistance thru lungs decreases & blood flow
preferentially bypasses ductus
Ductus closes & becomes ligamentum
arteriosum

6. Initial Care

Airway

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Maintain at level of mother’s vagina
Bulb suction
Gentle stimulation

Assess initial APGAR score

Prevent heat loss

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Gently dry
Swaddle in warm receiving blanket
Avoid air drafts
Skin-to-skin with mother
Cutting umbilical cord

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Do not milk the cord
Clamp 30 seconds after delivery
Clamp ~ 4 cm from newborn

8. At Birth

Is newborn full-term?

Is newborn breathing &/or crying?

Does newborn have good muscle tone?

9. At Birth

Is meconium present?

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Thin meconium
Thick meconium
Assess O2 saturation


60 – 70% at birth
May take 5 – 10 minutes to reach > 95%

Cyanosis common esp. acrocyanosis

HR ~ 150 – 180 slowing to 130 – 140

HR < 100 abnormal – begin resuscitation

10. The Distressed Newborn

11. Inverted Pyramid of
Resuscitation

12. Basic “Resuscitation”

Initial care

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Drying
Warming
Positioning
Suctioning
Tactile stimulation
Assessment

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Respiratory effort
Heart rate
Color

13. Airway

Ventilation

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Use neonatal BVM with pop-off valve
with supplemental oxygen

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
HR < 100
Apnea
Poor O2 saturation
Persistence of central cyanosis
Ventilate @ 40 – 60 bpm
Ventilate @ ~ 35 – 45 cm H2O
OR adequate chest rise
Supplemental oxygen

100% oxygen in the field

14. Neonatal Ambu Bag

15. Airway

Consider intubation

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Chest compressions
Difficult to ventilate
Thick meconium
Inadequate response

16. Chest Compressions

Encircle chest with both hands & use
thumbs

Compress lower half of sternum @ 100
per minute

Discontinue if HR increases to > 80

17. Vascular Access

MOST distressed newborns respond to
initial care, ventilation, & chest
compressions

If vascular access needed, can use
umbilical catheter


Umbilical cord with 2 arteries & 1 vein
Insert catheter into vein & secure with
umbilical tape

18. Medications

Naloxone


Glucose

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Do not use in newborn resuscitation
No specific glucose level at birth can be agreed upon
Prehospital glucose administration difficult
Epinephrine

0.05 - 0.1 mg/kg

(0.3 to 1 mL/kg of a 1:10,000 solution)

19. Specific Neonatal
Situations
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Meconium-stained amniotic fluid
Apnea
Diaphragmatic hernia
Bradycardia
Prematurity
Respiratory distress/cyanosis
Hypovolemia
Seizures
Fever
Hypothermia
Hypoglycemia
Vomiting
Diarrhea
Common birth injuries

20. Congenital heart conditions
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Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Tetralogy of Fallot
Transposition of the great vessels
Coarctation of the aorta
Pulmonary stenosis
Aortic stenosis

21. Failure to respond

Mechanical blockage

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Impaired lung function
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Pneumothorax
Diaphragmatic hernia
Pulmonary atresia
Central cyanosis

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Meconium
Congenital heart disease
Apnea
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Brain injury
Neuromuscular disease

22. Enroute to the call

Review how you will handle

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Normal birth & newborn
Newborn in distress

Warm patient compartment

Consider possibility of needing back-up
personnel

23. Remember….

Most newborns will respond to minimal intervention

If meconium is present AND…

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Child is vigorous, light suctioning
Child is flaccid, may need ETT + suction
If HR

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> 100, supplemental oxygen
Between 60 – 100, positive pressure ventilation
< 60, chest compressions

Rarely…..epinephrine thru umbilical vein

Reassess every 30 seconds

24. Questions?