Neonatal Resuscitation: BY DR Babatunde O.T

NEONATAL
RESUSCITATION
BY
DR BABATUNDE O.T.
Why learn neonatal resuscitation?
Birth asphyxia accounts for about 19% of
approximately 5 million neonatal deaths that occur
each year world wide (WHO, 1995)
About 10% of newborn require some assistance to
begin breathing at birth.
When resuscitation is needed, it must be initiated
without delay.
Why may a newborn need resuscitation?
Before birth, all of the oxygen used by a fetus diffuses across
the placental membrane from the mothers’ blood to the baby’s
blood.
Fetal lungs do not function as a source of oxygen or as a route

to excrete carbon dioxide.
The fetal lungs are expanded in utero, but the potential air sacs
(alveoli) within the lungs are filled with fluid, rather than air.
In addition, the arterioles that perfuse the fetal lungs

are markedly constricted, partly due to the low partial
pressure of oxygen in the fetus.
After birth, the newborn will no longer be connected
to the placenta and will depend on the lungs as the
only source of oxygen.
Therefore, in a matter of seconds, the lung fluid must be
absorbed from the alveoli, the lungs must fill with air that
contains oxygen, and the blood vessels in the lungs must
relax to increase blood flow to the alveoli so that oxygen
can be absorbed and carried to the rest of the body.
A failure of gaseous distension of the lungs or lack of
oxygen may result in sustained constriction of the
pulmonary arterioles, thus decreasing the blood flow to
the lungs and oxygen supply to body tissues.
RISK FACTORS
Maternal
Fetal
intrapartum
Why is apgar score not used to guide
resuscitation?
Apgar score is an objective method of quantifying the
newborn’s condition and is useful for conveying
information about the newborn’s overall status and
response to resuscitation.
However resuscitation must be initiated before

the 1-minute score is assigned.
Which babies require resuscitation?
All babies require the basic steps in neonatal
resuscitation.
Every birth should be attended by at least 1 person
who has been trained in initiating a neonatal
resuscitation, and whose sole responsibility is mgt of
the newborn.
Additional trained personnel will be necessary if a full
resuscitation is required.
Which babies require resuscitation?
With careful consideration of risk factors, more than
half of all newborns who will need resuscitation can be
identified prior to birth.
Recruit additional skilled personnel to be present.
Prepare the necessary equipment.

What personnel should be present at
delivery?
At every delivery, there should be at least 1 person who
can be immediately available to the baby as his/her
only responsibility and who is capable of initiating
resuscitation.
Either this person or someone else who is immediately

available should have the skills required to perform a
complete resuscitation, including endotrachael
intubation and administration of medications.
What personnel should be present at
delivery?
If delivery is anticipated to be high risk, and thus may
require more advanced neonatal resuscitation, at least
2 persons should be present solely to manage the baby
—1 with complete resuscitation skills and 1 or more to
assist.
Concept of resuscitation team.
For multiple births, a separate team should be

organised for each baby.
What equipment should be available?
All the equipment necessary for a complete
resuscitation must be in the delivery room and be fully
operational.
Laryngoscope size 0-preterm, 1-term
Successful approach to neonatal
resuscitation.
ANTICIPATION: allows recruitment of additional personnel
to assist with resuscitation and specific preparation of
equipments.
RECOGNITION: evaluating the infant, deciding on the

correct action to take and taking the action. Evaluation of
respiration, colour, tone. These are physical signs that serve
as the indicators for the ABCs of resuscitation
With a standardized approach to NR, all team mem. work

through the same decision tree in a coordinated manner.
The resuscitation flow chart
Initial assessment
-term gestation
-clear amniotic fluid
-breathing or crying
-good muscle tone
If no to any of the above, you provide warmth, position,

clear airway, dry stimulate, reposition. All within 30secs.
Then you evaluate simultaneously:
-respiration
-heart rate
-colour
If apneic or HR <100, assist respiration by providing effective

positive-pressure ventilation for 30 secs.
If breathing, HR > 100 but cyanotic, give supplemental

oxygen. Evaluate after 30sec. If still cyanosed, give positive
pressure ventilation.
If HR <60, support circulation by starting chest
compressions while continuing effective positive-pressure
ventilation. Evaluate after 30sec.
If still HR <60, administer epinephrine as you continue

positive-pressure ventilation and chest compressions.
When the heart rate improves and rises above 60 bpm,

chest compressions are stopped. Positive-pressure
ventilation is continued until the HR is above 100bpm and
the baby is breathing.
Improvement is indicated by the following 4 signs
-increasing heart rate
-improving colour
-Spontaneous breathing
-improving muscle tone
You may need to put a orogastric tube if prolonged
resuscitation is needed
Volume expanders may be needed.
Epinephrine
1:10000
Intravenous
Consider endotracheal
0.1-0.3ml/kg of 1:10000, 0.3-1ml/kg if endotracheal
rapidly
Endotracheal intubation
May be performed at various point of the resuscitation
flow chart.
Select the appropriate tube size
2.5 for <1000g
3.0 for 1000g-2000
3.5 for 2000-3000
3.5-4.0 above 3000
Depth is of insertion-( wt + 6)
What do you do after a resuscitation?
Babies who required resuscitation are at increased risk
of deterioration after their vital signs have returned to
normal
ROUTINE CARE
OBSERVATIONAL CARE
POST-RESUSCITATION CARE

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NEONATAL

Fetal lungs do not function as a source of oxygen or as a route

In addition, the arterioles that perfuse the fetal lungs

However resuscitation must be initiated before

Recruit additional skilled personnel to be present.

Prepare the necessary equipment.

Either this person or someone else who is immediately

Concept of resuscitation team.

For multiple births, a separate team should be

RECOGNITION: evaluating the infant, deciding on the

With a standardized approach to NR, all team mem. work

If no to any of the above, you provide warmth, position,

If apneic or HR <100, assist respiration by providing effective

If breathing, HR > 100 but cyanotic, give supplemental

If still HR <60, administer epinephrine as you continue

When the heart rate improves and rises above 60 bpm,

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