NEONATAL RESUSCITATION

Dr ARUN RAJ GR MD (Ped, Ayu), PDCR, PGDMRCH, MIPHA, FIAMR

Assistant Professor, Dept. of Kaumarabhritya
SDM College of Ayurveda & Hospital, Hassan, Karnataka
Email: drdrarunraj26@gmail.com; drarunraj@sdmcahhassan.org (work)
Ph: 9886292826
 Learning objectives
 To assess a newborn baby at birth
 Toperform basic resuscitation of a newborn
baby using standard equipment
 Resuscitationin special situations: meconium
stained liquor and preterm birth
 Tolearn principles of aftercare for a baby who
requires resuscitation at birth
Preparing for birth
Wash your hands

 Draught free, warm room - temperature >250C

 Clean, dry and warm delivery surface
 Radiant heater
 Two clean, warm towels/clothes
 A folded piece of cloth
 Self inflating bag - newborn size
 Infant masks in two sizes - normal and small newborn
 Suction device
 Oxygen (if available)
 Clock

Check if all equipments are in working order

Assessment at birth

 Deliverthe baby on to mother’s abdomen

 Note and call out time of birth

 Thoroughly dry the baby

 Use a warm towel
 Discard wet towel after drying

 Wrap the baby in another warm cloth

Keep the baby warm

 Assess breathing while drying
Care of the baby at birth
Assess breathing:
Assessment
Baby is crying
Baby is not crying, but
breathing at 30 to 60 times per
minute
Baby is gasping
Baby is not breathing
Decision
No need for resuscitation or
suctioning;
Start skin-to-skin contact and
breastfeeding
No need for resuscitation or
suctioning
Start resuscitation immediately
Start resuscitation immediately
Scenario 1
A mother arrived at your maternity hospital and
delivered a baby girl as soon as she reached the
labor ward. The placenta followed the baby and
mother was not bleeding.

 The baby was pink. She was breathing and heart

rate was 120/min.

 What is the Action?

Dry the baby
immediately after
birth
Immediate
skin-to-skin
Contact &
Breastfeeding
(routine care)
 Message 1

ONLY Routine care is required for a baby who

is crying or breathing normally;
Even routine suctioning is not required for
these normal babies
Scenario 2
A baby girl is born at your clinic after second stage
of 60 minutes. The umbilical cord is short.

 You see that the skin is pale .She is not

breathing. Heart rate is over 100/min.

 What is the Action?

Steps of resuscitation
 If
the baby is not breathing or
gasping

 Call for help!

 Cut cord quickly, transfer to a firm, warm
surface [under a radiant heater]
 Inform the mother that baby has difficulty
breathing and you will help the baby to
breathe
 Start newborn resuscitation
Steps of resuscitation
Position, clear airways
Steps of resuscitation
Position, clear airways
Steps of resuscitation
Position, clear airways (if needed)

Suction: Do not exceed duration of 20 sec

Steps of resuscitation
Dry, stimulate, reposition
Steps of resuscitation
Dry, stimulate, reposition
Steps of resuscitation
Dry, stimulate, reposition
Steps of resuscitation
Ventilate (if still not breathing)
Selecting Bag & Mask
equipment
 Size of bag: 240-750 ml
 Oxygen capability: Oxygen
source, reservoir
 Safety feature: Pop off valve,
pressure gauge (optional)
Steps of resuscitation
Ventilate
Use the CORRECT size face
mask that covers:
 The nose

 The mouth

 The tip of the chin

but not the eyes

Steps of resuscitation

Fitting a face mask:

 A face mask that is too LARGE

 Covers the eyes
 Extends over the tip of the chin

 A face mask that is too SMALL

 Does not cover the nose
 Does not cover the mouth effectively
Steps of resuscitation
Ventilate
 Squeeze bag with 2 fingers or
whole hand, 2-3 times
 Observe for rise of chest
 IF CHEST IS NOT RISING:
 Check seal
 Reposition the head
 Squeeze harder
 Once good seal and chest rising,
ventilate at 40 squeezes per minute
 Observe chest rise
 Check heart rate after 30 seconds
 Message 2

Bag and mask ventilation is required for a

baby NOT BREATHING or GASPING
Steps of resuscitation
When to stop ventilating?
 If baby is crying;
 If breathing >30/min, and

 NO chest in-drawing:
 If the skin between the ribs is
‘sucked’ inwards and the ribs
are prominent, the baby has
chest ‘in-drawing’
Steps of resuscitation
After stopping ventilation
 Put the baby in skin-to-skin contact on
mother’s chest
 Monitor every 15 minutes for breathing and
warmth
 Tell the mother the baby will probably be
well
 Encourage the mother to start breastfeeding
as soon as possible
NEVER leave the baby alone
Steps of resuscitation
When to continue ventilating?
If the baby
 is breathing at a rate of <30/min,
 is gasping
 has severe chest in-drawing

 Arrange for immediate referral

Steps of resuscitation
Referral
 Explain to the mother what happened, that
her baby needs help with breathing
 Ventilate during the referral

 Record the event on a referral form and

labour record

If the baby is NOT breathing even after 20

minutes, STOP ventilating
Scenario 3
Baby girl born at 38 weeks following thick
meconium stained amniotic fluid and
not breathing .

 The baby is blue. She was not breathing and

heart rate was 80/min.
 What is the Action?
 No need for intrapartum suction

Birth: assess
HR, breathing and tone

Vigorous: HR>100 Nonvigorous: any

good breathing parameter abnormal

Good tone

Initial steps Tracheal suction

 Message 3

 Meconium stained depressed baby needs

endotracheal suction prior to B&MV
Scenario 4
Mother admitted in maternity unit delivered
a baby boy at 32 week gestation on bed.
The baby is limp and not breathing.

 The baby is pale. He is not breathing and HR is

80/min.
 What is the Action?
Steps of resuscitation

Special considerations for preterm

 Be gentle
 Use small size resuscitation bag and give small tidal
volumes to move chest
 May need intubation, chest compression, medications
 Message 4

Preterm births need special precautions

before and during resuscitation
 Post resuscitation management

Principles
1. Keeping normal temperature
2. Maintaining oxygenation
3. Maintaining physiological milieu- fluids , glucose
4. Maintaining perfusion
5. Treating seizures
6. Monitoring organ function
 Care after resuscitation

 Place baby in skin-to-skin contact with mother

 Keep the baby warm

 Monitor every 15 minutes

 Start breastfeeding as soon as possible

 Discuss what has happened with the parents - be

positive!
 Do not separate the mother and baby unless the
baby has difficult breathing
Summary: Steps of resuscitation

1. Keep the baby warm: Place under the

radiant heater
2. Open the airway:
- Position baby’s head so it is slightly extended
- Suction the mouth and then the nose
3. If still not breathing: VENTILATE
4. If breathing or crying begins: STOP
VENTILATION
Summary: Steps of resuscitation

5. If breathing at <30 breaths per minute or

there is severe chest in-drawing:
CONTINUE VENTILATION
6. If no breathing or gasping after 20 minutes of
ventilation: STOP VENTILATION
7. Explain events to the mother and document
38