2. 2
What is Neonatal Resuscitation and related
programs?
Why needed ?
How it is done and overview of steps?
Special situations
For which babies provided and not for whom?
Who should provide?
3. Specifically designed by the American Academy of
Pediatrics to teach neonatal resuscitation in low-
resource settings. (cap, blanket, color inspection)
Has been taught to over 850,000 providers in 27
languages in 80 countries.
Trainee-trained provider
Pictorial algorithm
What is Neonatal Resuscitationand relatedprograms?
3
Definition: Neonatal resuscitation is a series of actions aims to support successful transition from fetal
intrauterine life to neonatal life.
There are 3prominent neonatal resuscitation programs used globally:
Developed by AAP applied over 130
countries
Need licensed provider attending every
birth
Requires advanced equipments in delivery
room (nCPAP
, ECG monitor).
Phrasal and geometric algorithm
Developed by the European
Resuscitation Council In 15 European
countries
Need licensed provider attending every
birth
Phrasal and geometric algorithm
Require radiant warmer,spo2 monitor and
pre warmed DR
Helping Babies
Breathe (HBB) 2010
Newborn Life
Support (NLS) 2001
Neonatal
Resuscitation
Program (NRP) 1986
5. Why Do we Need it???
5
1,200,000 neonatal lives are lost each year due to intrapartum-related events.
3 major universal challenges are pulmonary , circulatory and metabolic burden.
Ventilation is The most important and effective step in neonatal resuscitation, Unlike
adults.
% of Term Births Stabilization after birth
85% Spontaneously
10% Routine steps
5% Bag and mask
2% ETT
0.1-0.3% Compressions &Medications
8. NRP overview
8
Before delivery
1 –Risk factors 4 questions(Gestation, amniotic fluid,others, cord plan)
2-Identify team (one skilled for each baby )(2 skilled for those with risk
factors)
3-Team briefing and leader assignment
4-Equipment check
10. NRP overview
10
Initial steps
<60 sec
1 –5 initial steps include
2-Rapid evaluation( for tone and breathing/crying) if vigorous do
initial steps with mother , delay cord clamping 30-60 seconds
3- For non vigorous immediate cord clamping and do initial steps on radiant
warmer
5-Tracheal suction is not suggested in meconium-stained babies.
6-SPO2 monitor is needed if oxygen will be used for cyanosis (no visual
assessment)
Warmth Radiant warmer and dry
towels, head cap for 32-
polyethylene bag if <32)
Drying skin For those >=32 weekers
Stimulate By rubbing back and
extremeties Do Not shake or
slap baby
Positioning Sniffing morning air position
Suction Only if needed either by
bulb syringe or catheter M
before N
12. NRP overview
12
PPV within 60sec
The single Most important and Most effective step.
Used When Not breathing OR Gasping OR HR is < 100 OR persistent cyanosis on oxygen
Equipment Self inflating flow inflating T-piece
Face mask ETT Laryngeal mask
HOW to
Check After 15 sec.,then after 5 breathes with MRSOPA correction
SUCCESS Rising heart rate with chest moving Keep till HR>100
Failure move to next step if HR<60 despite 30 sec of proper PPV
Time Frame Start within 60 Sec of birth consider OGT if >60 sec PPV
Settings for Manual PPV during NRP
Fio2 For those GA >=35wks 21%
For those GA <35wks 21% -
30%
Pressure
PEEP??
20-25 cmH2O upto 40 by
manometer or half squeezing
the 250ml bag
Rate 40-60 per minute
Time “BREEZE, TWO, THREE”
13. 13
It is uncommon to need this step.
Used When HR< 60 AND at least 30 seconds of proper (PPV)
with ETT or laryngeal mask
HOW to
Check A After each minute better with cardiac monitor
Failure HR <60 after 30 sec PPV AND 60 sec compression
Give Epinephrine (1:10000) through UVC, IO, (0.2ml/kg) or
one dose ETT(0.5-1 ml/kg) Repeat every 3-5 minutes.
With ongoing PPV and compressions.
If shock Normal saline (NS) or type O- blood 10 ml/kg over 5-10 minutes
Compression &
Medications
How to apply chest compressions
Fio2 100%
Thumbs on the sternum, in the center, just
below an imaginary line connecting the
baby's nipples
Encircle the torso with both hands.
Support the back with your fingers
One third (AP) diameter of the chest
Rate to PPV 3:1 for 30 cycles/min
ONE AND TWO AND
THREE AND BREEZE AND
16. 16
Post Resuscitation
Care
Close monitoring of 8 items for those who needed resuscitation beyond initial
steps:
Respiration Oxygenation Temperature BP
Blood Glucose Electrolytes Urine output Neurologic status
Cessation of Resuscitation Time frame for considering cessation of resuscitation
efforts is around 20 minutes after birth. This should be discussed with the team and
family.
Post care Debriefing Identify a series of small changes that can result in significant
improvement
18. 18
If a baby fails to improve suspect pneumothorax if generalized edema suspect pl. effusion. no time
for CXR, pneumothorax or pleural effusion needs thoracocentesis
Robin sequence prone position, nasopharyngeal tube or laryngeal mask
Bilateral choanal atresia oropharyngeal airway
CDH no mask ventilation, intubate and insert OGT
Mother received opiates and respiratory depression no naloxone assisted ventilation support
Myelomeningocele (spina bifida) no supine. Position the newborn lying on their side, on their stomach
Gastroschisis or omphalocele Place the lower body and abdomen sterile, clear plastic bowel bag and
secure the bag across the baby`s chest
19. 19
1-It is all based on what is the best for newborn
2-If the responsible physician believes that no chance for survival (lethal congenital
anomalies) DNR
3-Parents are the best surrogate if there is high risk for mortality or significant burden of
morbidity they should participate in decision as in those <23 weeks GA
20. 20
Anyone who is involved in the care of a newborn.
Anyone who attend births and are responsible for anticipated resuscitation of a newborn with known risk
known risk factor
Be sure that your hand will make a difference one day they will save a life
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