A little reminder of some important neonatal resuscitation points.
- Dry and stimulate the infant under a radiant warmer (get rid of wet towels). Infants lose heat fast!!
- Place in a sniffing position. Remember that the infants occiput is large, elevation of the shoulders with a blanket is usually needed.
- Suction the mouth then the nose carefully, as vigorous suction can cause bradycardia secondary to a vagal response. Deep meconium suction in the term, vigorous, neonate is not needed. Meconium-stained neonates who are not vigorous, require PPV, or subsequently develop respiratory distress should be suctioned until clear then an ET tube placed.
- If the child does not perk up in 30 seconds start positive pressure ventilation (PPV) at 40 to 60 breaths per minute. PEEP valves up to 30ccH2O may be needed. Little babies do poorly with pulmonary issues early use of PPV is a must to avoid cardiopulmonary collapse. Effective ventilation = positive heart rate response.
- Consider intubation, although bagging little babies is easily done…resus first intubate only when needed.
- If the heart rate is less than 100 bpm, try PPV and recheck the heart rate in 30 seconds. If the heart rate is less than 60 bpm start chest compressions and PPV at 3:1
- Still not working….epinephrine is the drug of choice for refractory neonatal bradycardia in a dose of 0.1 to 0.3 mL/kg of a 1:10,000 solution. Dont forget fluid resuscitation if hypovolemia is high on the differential.
Escobedo M. Moving from experience to evidence: changes in US Neonatal Resuscitation Program based on International Liaison Committee on Resuscitation Review. J Perinatol. 2008 May;28 Suppl 1:S35-40.
Rajani AK, Chitkara R, Halamek LP. Delivery room management of the newborn. Pediatr Clin North Am. 2009 Jun;56(3):515-35