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Neonatal Resuscitation Guidelines

Neonatal resuscitation is the process of reviving and stimulating a newborn baby to breathe. Proper breathing is essential for the baby's blood flow, circulation and body temperature. It is recommended worldwide that a specialist trained in neonatal resuscitation be present at every birth to ensure those in need of assistance receive the necessary care.

  1. The Facts

    • According to Pediatrics, the official journal of the American Academy of Pediatrics, "A minority (fewer than 10 percent) of newly born infants require active resuscitative interventions to establish a vigorous cry or regular respirations, maintain a heart rate >100 beats per minute (bpm), and achieve good color and tone." The American Heart Association adds to this by citing, "About 1 percent requires extensive resuscitative measures." Although most infants will not need any resuscitation measures, it is recommended by the Pediatric Working Group of the International Liaison Committee on Resuscitation (ILCOR) that a medical specialist trained in resuscitation procedures be present at every birth.

    Symptoms

    • According to the American Heart Association, four evaluative questions should be used when identifying the risk of asphyxiation and a need for resuscitation. First, determine if the baby is full term. Second, identify whether the "amniotic fluid is clear of meconium and evidence of infection." Third, observe whether the baby is actually breath of crying on its own. Finally, determine whether the baby's muscle tone is good. If the observations of these questions elicit a negative response, resuscitation should be administered.

    Causes

    • Neonates who are born premature or have been labeled high-risk pose the greatest risk of requiring resuscitation. Asphyxiation may also arise due to inhalation of meconium, an insufficient placenta, or a kink or blockage of the umbilical chord.

    Equipment

    • According to Robin L. Bissinger, NNP, MSN, RNC, Ph.D, neonatal nurse practitioner coordinator and assistant professor of nursing at the Medical University of South Carolina College of Nursing, the following supplies should be present at every birth for use if resuscitation is required. For respiration, it is recommended that the room contain an oxygen supply, assorted masks, a neonatal bag and tubing to connect to an oxygen source, manometer, endotracheal tubes (2.5-4), tape and scissors, laryngoscope (0 and 1 sized blades) and extra bulbs and batteries. For suction techniques, the room should contain a bulb syringe, regulated mechanical suction, suction catheters (6F, 8F, 10F), suction tubing, suction canister, replogle or Salem pump (10F catheter), feeding tube (8F catheter), syringe (catheter tipped, 20 mL) and meconium aspirator. Epinephrine also should be on hand in case it's needed.

    Procedure

    • According to the American Heart Association, resuscitation is a four-step process. First, take measures to stabilize the infant. These include providing warmth to prevent hypothermia, positioning the baby so that fluid is able to clear the lungs, clearing the airway, drying the baby and stimulating the infant to breath and cry. If these measures prove unsuccessful, the second phase includes ventilation. Third is the use of chest compressions. The final technique is "Administration of epinephrine and/or volume expansion."

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