Neonatal resuscitation

Use this note for the non-delivery related resuscitation of the newborn; see newborn resuscitation for immediate after-delivery resuscitation. See newborn critical care quick reference for vital signs and drug doses, and equipment sizes.

Background

  • Neonate <1mo age

Clinical Features

Differential Diagnosis

Sick Neonate

THE MISFITS [1]

Evaluation

Workup

  • Blood glucose (stat)
  • Sepsis workup
  • Blood gas
  • ECG
    • Treatable conditions include SVT
  • Ammonia, pyruvate and lactate to rule in inborn errors of metabolism
    • Need to look up values for neonate. Ammonia is high as liver is immature (i.e. that's why neonates are jaundice). Ammonia > 200 requires dialysis

Evaluation

If hypoxic or evidence of CHF assume CHD

  • CHF in neonate = hepatomegaly, wheezing, gallop
  • if unclear, do Hyperoxia test
    • place infant on 100% O2 for 10 minutes
    • check ABG, if O2<100 torr, highly predictive of CHD
    • some use Pulse Ox <95%, less sensitive
  • Abdominal xrays may help rule in intestinal disaster early

Pediatric Hypoglycemia Dextrose Chart

Category Age Glucose Treatment Initial IV Bolus Maintenance Dose
Neonatal <2mo <40 D10W 2.5-5 mL/kg 6 mL/kg/h
Pediatric 2mo-8yrs <60 D25W 2 mL/kg

D10W:

  • 6 mL/kg/h for first 10 kg
  • + 3 mL/kg/h for 11–20 kg
  • + 1.5 mL/kg/h for each additional kg >20 kg
Adult >8yrs <70 D50W 50mL (1 amp) OR 1 mL/kg
  • Consider diluting the D25W or D50W bolus, with NS 1-to-1, as those concentrations may be sclerosing to veins
  • Recheck 5 minutes after dose and repeat dose if low.
  • Consider glucagon IM/SQ if IV access is not readily available

Management

Other Empiric Treatments for Unstable Neonates

Medication/Intervention Indication Dose/Size (for neonate)
Glucose Hypoglycemia 5–10 mL/kg of 10% dextrose in water IV
3% normal saline Symptomatic hyponatremia 3–5 mL/kg bolus IV
Calcium Hypocalcemia 50–100 milligrams/kg calcium gluconate or 20 milligrams/kg calcium chloride IV
Packed red blood cells Anemia 10 mL/kg IV
Normal saline Hypotension, dehydration 5-10 mL/kg IV aliquots (up to 60-80 mL/kg)
10% dextrose in one fourth normal saline Metabolic disease 1.5 maintenance (6 mL/kg/h for the first 10 kg)
Endotracheal intubation Hypoventilation or frequent apnea <3mm for preemie; 3mm for term neonate, 3.5mm for older infant; cuffed tube prefered if not premature

Disposition

  • Admit

See Also

Pediatric Critical Care

Calculators

APGAR Score

APGAR Score
Criteria 0 1 2
Appearance (Color) 1 Blue/pale all over Blue extremities, pink body Pink all over
Pulse (Heart Rate) 1 Absent <100 bpm ≥100 bpm
Grimace (Reflex Irritability) 1 No response Grimace/weak cry Cry or pull away
Activity (Muscle Tone) 1 Limp Some flexion Active motion
Respiration 1 Absent Slow/irregular Good cry
APGAR Score / 10
Interpretation
0–3 Critically low — Immediate resuscitation needed.
4–6 Moderately low — May require some resuscitative measures.
7–10 Reassuring — Routine neonatal care.
References
  • Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-267.
  • American Academy of Pediatrics Committee on Fetus and Newborn. The Apgar Score. Pediatrics. 2015;136(4):819-822. PMID 26416932.

External Links

References

  1. ↑ Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.
  2. ↑ Harbor-UCLA ID Guidelines 2026
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