Neontala Resucitation

Neonatal Resuscitation

Annotation summary:

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Newly born infants undergoing transition from intrauterine to extrauterine life,

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The terms newborn and neonate are intended to apply to any infant during the initial hospitalization. The term newly born is intended to apply specifically to aninfant at the time of birth.

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Approximately 10% of newborns require some assistance to begin breathing at birth. Less than 1% require extensive resuscitative measures.

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Those newly born infants who do not require resuscitation can generally be identified by a rapid assessment of the following 3characteristics:

! Term gestation?

! Crying or breathing?

! Good muscle tone?

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A. Initial steps in stabilization (provide warmth, clear airway if necessary, dry, stimulate) B. Ventilation C. Chest compressions D. Administration of epinephrine and/or volume expansion

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60 seconds (“the Golden Minute”)

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Simultaneous assessment of 2 vital characteristics: respi-rations (apnea, gasping, or labored or unlabored breathing) and heart rate (whether greater than or less than 100 beats per minute). Assessment of heart rate should be done by intermittently auscultating the precordial pulse.

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A pulse oximeter can provide acontinuous assessment of the pulse without interruption of other resuscitation measures, but the device takes 1 to 2 minutes to apply, and it may not function during states of very poor cardiac output or perfusion.

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Simultaneous evaluation of 3 vital characteristics: heart rate, respirations,

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Atevery delivery there should be at least 1 person whose primary responsibility is the newly born.

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Preterm babies also have immature blood vessels in the brain that are prone to hemorrhage; thin skin and a large surface area, which contribute to rapid heat loss; increased susceptibility to infection; and increased risk of hypovolemic shock related tosmall blood volume.

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The initial steps of resuscitation are to provide warmth by placing the baby under a radiant heat source, positioning the head in a “sniffing” position to open the airway, clearing the airway if necessary with a bulb syringe or suction catheter, drying the baby, and stimulating breathing.

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Very low-birth-weight (!1500 g) preterm babies are likely to become hypothermic despite the use of traditional techniques for decreasing heat loss.

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Additional warming techniques are recommended

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Infants born to febrile mothers have been reported to have a higher incidence of perinatalrespiratory depression, neonatal seizures, and cerebral palsy and an increased risk of mortality.

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There is evidence that suctioning of the nasopharynx can create bradycardia during resuscitation21,22 and that suctioning of the trachea in intubated babies receiving me-chemical ventilation in the neonatal intensive care unit (NICU) can be associated withdeterioration of pulmonary compliance and oxygenation and reduction in cerebral blood flow velocity when performed routinely

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It is recommended that suctioning immediately following birth

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Suction-ing of the oropharynx before delivery of the shoulders was considered routine until a randomized controlled trial...