Neonatal Resuscitation – At A Glance

This is one of the core topics of Neonatalogy, which should be known by all to reduce the mortality and morbidity.

Neonatal resuscitation takes place after delivery of a new borne.
If time permits, you can introduce yourself to the mother and tell her that you are going to take care of her baby after delivery

Preparation of all instruments and medications is ultra important. As a house officer you have to ensure that all medication (Adrenalin, Dextrose, Sodium bicarbonate) is prepared prior to attempting neonatal resuscitation and warmer is switched on and it’s functioning properly, bag mask valve is available with adequate size mask and towels.

After preparing all these instruments have to make sure hands are properly washed to avoid transmission of infections to the baby.

After receiving the baby, first thing to do is to dry and cover the baby and place the baby in the warmer.
Then we have to assess CBT-HR

  • Colour
  • Tone
  • Breathing 
  • Heart rate

With this assessment we can get an idea about the cardiorespiratory system
If a baby is floppy, cyanosed with irregular breathing – Should start resuscitation immediately
It is given according this order – TABCD

  • Tactile stimulation
  • Airway
  • Breathing
  • Circulation 
  • Drugs 

Tactile stimulation can be given at the time of drying the baby

Airway – To open the airway baby is kept in the neutral position. We can ensure that it is in the correct position by placing the baby’s face parallel to the surface

Breathing – If the baby is still not crying / no breathing, have to give inflatory breathing using bag mask valve (Ambo bag). For this we have to ensure that the mask is a perfect fit for the baby. Otherwise the baby would not receive adequate breaths. The mask should pass above the root of the nose and above the chin.
Inflatory breaths are given over 1 second (123 release, 223 release…. 523 release) and 5 inflatory breaths are given
While giving inflatory breaths have give attention to the chest movements to see whether they are expanding appropriately.
In the bag mask valve, there is a blowout valve which helps to keep the pressure at the optimum level and to prevent the baby from getting a pneumothorax
If there is inadequate chest movements – Do chin lift and jaw thrust and attempt inflatory breaths again
If still no adequate chest movements have to establish the airway using devices – Can insert an oropharyngeal tube which is easier to insert.
To insert an oropharyngeal tube – First have to measure the appropriate size, that is from the first upper inciser teeth to the tragus
If this fails have to inform the seniors for the insertion of an ET tube

Circulation – After establishing breathing, have to assess the heart rate. If it is less than 60 beats/min have to start CPR at a ratio of 3 : 1 (3 chest compressions and 1 ventilatory breath)
After giving 15 ventilatory breaths have to reassess the patient, if heart rate is still low have to give drugs
Chest compressions are given below the nipple line by using thumb encircling method and should compression 1/3rd of the anteroposterior diameter of the chest.

Drugs – 1 : 10000 Adrenalin 0.01ml/kg given IV
If the neonate is hypoglycemic – Dextrose can be given
If the neonate is acidotic – 4.2% Sodium bicarbonate (Double diluted – Diluted with dextrose) can be given

Proper documentation is essential

Have to send information to the PBU for prepare the incubators

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