Newborn resuscitation

Use this note for immediate after-delivery resuscitation; see neonatal resuscitation for the non-delivery related resuscitation of the newborn.

Background

Newborn Vital Signs

• HR RR SBP^
• >100 40-80 60-70

^<3kg (premature) SBP = 40-60

Differential Diagnosis

Common Newborn Problems

• Hypoxia
  • Primary apnea
  • Secondary apnea
• Hypothermia
• Hypoglycemia
• Meconium aspiration

Diagnosis

Assessment Triad

• Respiration- adequacy, difficulty
• HR >100, umbilical
• Color

Treatment

Resucitation Inverse Pyramid

1. Dry, warm, position, suction, stimulate
   • position: neutral (towel --> thorax)
   • suction: oral then nasal
   • stim: along spine or feet
   • check glucose^
2. Oxygen (use liberally)
3. Ventilate (40-60 breaths/min @ 20-25 cmH20)
   • BVM (indications)
     • Apnea/gasping
     • HR <100/min
     • Persistent cyanosis
   • ET^^ (indications); ETT size = Gest age (wks) / 10
     • BVM ineffect after 30s
     • Suction meconium**
4. Chest compressions (indications)
   • HR <60 after above x 30 sec
     • 120/min (resp 3:1)
     • Stop when HR > 60
5. Medications^^^^
   • Epi (0.01-0.03 mg/kg)
   • D10W (4 mL/kg = 0.2gm/kg)
   • Nalaxone (0.4 mg/kg)
     • For opiod use <4hrs
   • NS (10 mL/kg boluses)
   • Dopamine drip
     • (5-20 mcg/kg/min)
   • NaHCO3 - prolonged resus
     • (1-2 meQ/kg)

^Hypoglycemia (give D10W)

• >2.5 kg = <40 mg/dL
• <2.5 kg = <30 mg/dL

^^Meconium Suctioning Indications

• Meconium + -->
  • absent/depressed resp
  • poor muscle tone
  • HR <100

(2 passes w/ ET + suction)

^^^Newborn Vent Settings

Pressure Cycled: RR 30+, PIP 20/2 (Preemie 15/2)

Preemie (<23-24 wks or 500 gms)

• rapid volume may inc risk of IVH
• usually ETT immed

Equipment

• blankets, warmer, umbilical clamps
• Bulb suction or wall suction
• Catheters (5F,8F,10F)
• Meconium aspirators
• BVM
• ETT 2.5-4.0 w/ stylets
• Blades 0 & 1
• IV catheters (22 & 24 g)
• Umbilical caths (3.5 F & 5F)
• syringes, 3 way stop cocks
• Epi 1:10,000
• Naloxone 0.4 mg/ml or 1 mg/ml
• NaHCO3 4.2% or 8.4%
• NS & D10W

See Also

• Neonatal Resuscitation
• PALS (Main)
• Umbilical Vein Catheterization
• Transient tachypnea of the newborn
• Emergent delivery