• At every delivery there should be at least one person with the skills required to perform a complete resuscitation. When that person is caring for the mother, another person capable of initiating and assisting with resuscitation must be primarily responsible for the infant, even when a normal, healthy infant is expected.

After completing initial steps baby is assessed for respirations, heart rate and color.

• Routine care of healthy term newborn not discussed.

 

 

 

 

 

Initial steps

• Dry, remove wet linen, position, suction, stimulate to breathe, if necessary.

• Then assess respirations and intervene, if necessary.

• Then assess heart rate and intervene, if necessary.

• Then assess color and intervene, if necessary.

 

 

Assessment is done in the sequential manner for respirations, heart rate and color

• In situations of meconium stained liquor for oropharyngeal suction use 10 F or larger suction catheter.

• Tracheal suctioning is indicated for all infants who are depressed and have meconium and for any infant passing through thick particulate meconium stained liquor.

• Tracheal suction should be repeated till returns are clear. If the baby is severely depressed positive pressure ventilation may be needed even if some meconium remains in the airway.

• Chest compressions are indicated when the heart rate, after 15-30 seconds of positive pressure ventilation with 100% oxygen, is below 60 bpm or between 60 and 80 bpm and not increasing.

• Chest compressions are stopped if the heart rate >80/bpm

• Lower third of the sternum is located by imagining a line drawn between the nipples.

• During chest compressions, depress the sternum ½ to ¾ inch.

• Epinephrine is indicated when the heart rate remains below 80 bpm despite a minimum of 30 seconds of adequate ventilation with 100% oxygen and chest compression or if the heart is zero.

• Outlines general instructions for epinephrine administration via endotracheal tube.

• Volume expanders include 5% albumin.

• Indication for naloxone hydrochloride.
  Severe respiratory depression and a history of maternal narcotic administration within the past 4 hours.

• No medication administration performance checklist provided.

• No Lesson 7

• At every delivery, there should be at least one person whose primary responsibility is the baby and who is capable of initiating resucitation. Either that person or someone else who is immediately available (not at home or in a remote hospital location) should have the skills required to perform a complete resuscitation, including endotracheal intubation and administration of medications.

Assessment of the newborn begins at the time of birth. The five questions clearly differentiate the baby in need of assistance from the baby who can receive routine care. If the answer to any of these initial assessment questions is no, the baby requires the initial steps under the radiant warmer. If all answer are yes, the baby can be provided routine care:

1. Is the amniotic fluid clear of meconium?

2. Is the baby breathing or crying?

3. It there good muscle tone?

4. Is the baby’s color pink?

5. Is the baby term?

 

• Nearly 90% of newborns are vigorous term babies with no risk factors and clear amniotic fluid. They can be directly placed on mother’s chest, dried and covered with dry linen. Warmth is maintained by direct skin-to-skin contact with the mother. Clearing of the upper airway can be provided as necessary by wiping the baby’s mouth and nose. Ongoing observation of breathing, activity and color should be carried out.

Initial steps: If deemed necessary:

• Position, clear airway, dry, remove wet linen, stimulate, reposition, give oxygen as necessary.

• Simultaneously, evaluate respirations, heart rate color during the initial steps.

• If the baby is breathing and cyanotic or begins to breathe during the initial steps and is cyanotic, administer free-flow oxygen. After completion of the initial steps, base further interventions on simultaneous assessment of respirations, heart rate and color.

• For oro-pharyngeal suction use 12 F or larger suction catheter.

• The need to suction the trachea for meconium is determined by whether or not the baby is vigorous at birth. Vigor is defined by strong respiratory effort as evidenced by cry, good muscle tone, and a heart rate >100 bpm. If any of the criteria is not met, the newborn requires tracheal suctioning. Thin or thick meconium does not guide need for intubation.

• If you recover meconium with the first suction, check the heart rate. If the baby does not have significant bradycardia, reintubate and suction again. If the heart is low you may decide to administer positive pressure ventilation without repeating the procedure.

• Chest compressions are indicated when the heart rate remains at <60 bpm despite 30 seconds of effective positive-pressure ventilation.

• Chest compressions are stopped if the heart rate >60/bpm.

• Lower third of the sternum is located by running finger along the lower edge of ribs till xiphoid. Area just above xiphoid is used for chest compression.

• Depress the sternum one-third of the anterior-posterior diameter of the chest.

• Epinephrine is indicated when the heart rate remains below 60 bpm despite 30 seconds of assisted ventilation and another 30 seconds of coordinated chest compressions and ventilation.

• Outlines detailed instructions for epinephrine administration via emergency umbilical venous catheter as well.

• 5% albumin has been deleted from the list of volume expanders.

• Indication for naloxone hydrochloride.
  Severe respiratory depression and a history of maternal narcotic administration within the past 4 hours after 30 seconds of positive-pressure ventilation has restored normal heart rate and color.

• A medication administration performance checklist evaluates the learner’s ability to administer epinephrine via endotracheal tube and to assist with placement of or place an emergency umbilical venous catheter and administer volume expander and/or medication.

• Lesson 7 includes information on:

• Speical situations that may complicate resuscitation and cause ongoing problems.

• Subsequent management of the baby who has required resuscitation.

• How NRP principles apply to babies beyond the immediate newborn period or outside the hospital delivery room?

• Ethical considerations about starting, non-initiation and stopping resuscitation.