King Faisal University

College of Applied Medical Sciences

Respiratory Care Department
MSRT411: Perinatal and Pediatric Respiratory
Care

Postnatal Assessment
and Resuscitation
Ghazi Alotaibi, PhD, RRT

Lec05-Sep27
 Critical Moments in
Everybody’s Life
 The first moments of life
are very critical.
 From intrauterine life to
extrauterine life
 Need to establish new
pattern of circulation.
 Need to establish new
system for gas exchange.
 Steps for Proper Care
of Newborn
 Step 1: Preparation.
 Step 2: Stabilization.

 Step 3: Assessment.

 Step 4: Resuscitation.
Step 1: Preparation
 Anticipation of high risk delivery
 Maternal history, history of pregnancy, monitoring
during labor and delivery.
 Skilled personnel should be available (MD,
RT, RN).
 Availability of prearranged plan.
 Availability of Equipment
 Different sizes (resus. bags, masks).
 Check for proper function.
 Radiant warmer
Step 2: Stabilization.
 A. DRY AND WARM:
 Once delivered, newborn is dried and warmed to
prevent heat loss.
 Warmed in preheated radiant warmer, or warmed
blankets.
 What is the mechanism of heat loss in Neonates?
 For babies <1500 g, use polyethylene wrapping to
prevent heat loss but allows radiant heat transfer.
 B. MAINTAIN OPEN AIRWAYS:
 Neck slightly flexed.
 Small roll under the shoulder.
 If no respiratory effort, reposition the head.
 Suction mouth, then nose using bulb syringe
or suction catheter.
 Suction may cause bradycardia WHY??
 Suction: depth< 5 cm, for 5 sec, suction
pressure <100 mm Hg.
 If meconium is suspected:
 Suction moth, pharynx, and nose as the head
is delivered.
 No stimulation until the airway is cleared,
Why??
 If signs of distress are present with the
present of meconium: Intubate, Suction,
Extubate.
 C. Stimulation:
 If no strong cry, respi. effort, limb movement:
Stimulate baby.
 How?
 Flicking the bottom of the feet
 Rubbing the back
 No shaking, spanking or upside down holding.
 If no effective spont. breathing after
stimulation: start resuscitation.
Step 3: Assessment of
Neonate
 Assessment should evaluate:
 Respiratory effort.
 HR
 Color
 APGAR Score
 Visual assessment of external structures.
 Respiratory Effort:
 Normally: spontaneous crying with adequate
respiratory arte and depth.
 Inadequate respiration (absent, shallow,
gasping): PPV with 100% oxygen.
 Shallow breathing could be deceiving (does
not guarantee adequate pulse rate). WHY?
 Hear Rate:
 How to assess HR in Neonates?
a. Grasping the base of the umbilical cord.
b. Stethoscope.
c. Feeling brachial or femoral pulse.
 If HR < 100: PPV
 If HR < 60 start chest compressions.
 Color:
 Not sensitive indicators of baby’s condition as
heart rate.
 Peripheral cyanosis is common shortly after
birth. Why?
 Oxygen may not be necessary.
 If central cyanosis is present with adequate
respiration and HR > 100: give oxygen.
 APGAR Score
 Evaluate 5 factors. (HR, RR, Color, Reflex,
and muscle tone)
 Provides a clinical pictures of baby’s
condition after delivery.
 APGAR score at 1-min help guide the
appropriate clinical intervention.
 Still the best index of postnatal health.
 Resuscitation has the priority over assigning
APGAR scoring.
 APGAR score is performed at 1- and 5-min.
 Why at 5-min??
 Interpretation of APGAR Scores:
 7-10: Observe
 4-6: O2 and stimulation
 0-3: Resuscitate.
 If < 7, APGAR score should be repeated
every 5 minutes until score > 7.