Neonatal Resuscitation

The successful transition to extrauterine life depends heavily on the ability of the neonatal pulmonary system to adapt quickly and provide oxygen to the infant. Any illness or injury

Box 22-2 Neonatal Resuscitation Supplies and Equipment for Delivery of a Term Infant

Suction equipment

Bulb syringe

Mechanical suction and tubing Suction catheters

8-F feeding tube and 20-mL syringe Meconium aspirator

Bag and mask equipment

Neonatal resuscitation bag with a pressure-release valve or pressure manometer

Face masks, newborn and premature sizes Oxygen source with flow meter and tubing

Medications and supplies to be immediately available if necessary

Epinephrine 1:10,000

Isotonic crystalloid for volume expansion

Sodium bicarbonate 4.2%

Naloxone hydrochloride (0.4 mg/mL)

Dextrose 10%

Normal saline for flushes

Umbilical vessel catheterization supplies

Syringes and needles


Gloves and appropriate personal protection Radiant warmer or other heat source Firm, padded resuscitation surface Clock

Warmed linens and dry blankets


Oropharyngeal airways

Intubation equipment

Laryngoscope with straight blades, no. 1 Extra bulbs and batteries for laryngoscope Endotracheal (ET) tubes, sizes 2.5, 3.0, 3.5, and 4.0 mm Materials to secure ET tube in place

Modified from Kattwinkel J (ed): Textbook of Neonatal Resuscitation, 5th ed. Elk Grove Village, Ill, American Academy of Pediatrics and American Heart Association, 2006.

that interferes with oxygenation puts the infant at great risk and should be identified and treated promptly. It is important that with every delivery, at least one person trained in neonatal care and resuscitation be assigned to care specifically for the infant. Caregivers should have immediate access to the necessary equipment for a complete resuscitation. If there is concern that the newborn will be at high risk for complications (e.g., thick meconium, fetal heart rate decelerations, known fetal anomalies), appropriate equipment should be set up and ready to use immediately (Box 22-2).

The American Academy of Pediatrics and American Heart Association developed specific protocols for neonatal resuscitation (AAP and AHA, 2006). An adapted resuscitation algorithm is given in Figure 22-1. This chapter does not cover the protocol in sufficient detail to produce competency in neonatal resuscitation and should not be used as a substitute

Meconium stained amniotic fluid?

HR < 60

Consider volume expansion, obtain vascular access Treat underlying illness

Figure 22-1 Algorithm for neonatal resuscitation. ET, Endotracheal; HR, heart rate.

(Modified from John Kattwinkel J (ed). Textbook of Neonatal Resuscitation. 5 th ed. American Academy of Pediatrics and American Heart Association, Elk Grove Village, ill, 2006.)

for participation in the AAP/AHA Neonatal Resuscitation Program (NRP). The ABCs of neonatal resuscitation are the same as adult resuscitation: clear and position the airway, make sure the infant is breathing (whether spontaneously or with support), and ensure circulation of oxygenated blood.

Initial stabilization procedures after every delivery should include warming and drying the infant, removing wet towels quickly, and providing tactile stimulation to encourage vigorous breathing and good muscle tone. After necessary resuscitation is completed, all neonates should receive che-moprophylaxis for ophthalmia neonatorum with 1% tetracycline ophthalmic ointment, 0.5% erythromycin ophthalmic ointment, or 1% silver nitrate aqueous solution. All three medications have similar efficacy; however, silver nitrate is preferred in areas with appreciable incidence of penicillin-ase-producing Neisseria gonorrhoeae. Silver nitrate is more likely than tetracycline or erythromycin to cause a transient chemical conjunctivitis in the first 1 or 2 days of life (AAP, 2003a).

Infants should also receive 1.0 mg of vitamin K intramuscularly early after delivery to prevent vitamin K-deficiency bleeding (VKDB, previously hemorrhagic disease of the newborn) (AAP, 2003b; Puckett and Offringa, 2000). Concerns about a correlation between intramuscular (IM) vitamin K and childhood leukemia have not been validated, and there is insufficient data to show that oral vitamin K prevents late-onset VKDB; therefore, IM vitamin K should be administered to all newborns (AAP, 2003b).

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