Overview
Neonatal Resuscitation is a critical emergency procedure performed on newborns who fail to establish adequate breathing and circulation after birth. This systematic approach follows the Neonatal Resuscitation Program (NRP) algorithm and involves assessment, intervention, and evaluation in a structured manner.
Neonatal resuscitation is crucial for preventing neonatal mortality and morbidity. Approximately 10% of newborns require some form of resuscitation, with 1% requiring extensive resuscitation. Proper technique can prevent brain damage, organ failure, and death. This procedure is essential for all healthcare providers involved in newborn care.
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Indications
Newborn not breathing or breathing inadequately
Heart rate less than 100 beats per minute
Central cyanosis despite oxygen administration
Flaccid or hypotonic newborn
With depressed or absent respiratory effort
Preterm infants with respiratory distress
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
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Pre-procedure Preparation
Preparation includes ensuring all resuscitation equipment is available and functional, checking oxygen supply, preparing warming equipment, and assembling the resuscitation team. All team members should be trained in NRP protocols and understand their roles. The delivery room should be properly equipped and maintained at appropriate temperature.Step-by-Step Procedure
Step 1: Initial Assessment and Preparation
Begin resuscitation immediately after birth. Place newborn on preheated radiant warmer. Dry thoroughly and remove wet linen. Assess breathing, heart rate, and color. Position head in neutral position.
⚠️ Common Mistakes to Avoid:
- Delayed initiation of resuscitation
- Inadequate warming leading to hypothermia
- Poor positioning causing airway obstruction
💡 Pro Tip:
Remember the golden minute - most newborns respond within 60 seconds of appropriate intervention.
Step 2: Airway Management
Clear airway if needed. Suction mouth then nose if meconium present. Position head in neutral position. Consider oropharyngeal airway if needed. Ensure proper head positioning.
⚠️ Common Mistakes to Avoid:
- Deep suctioning causing bradycardia
- Poor head positioning
- Inadequate airway clearing
💡 Pro Tip:
Avoid deep suctioning as it can cause bradycardia and apnea.
Step 3: Breathing Assessment and Support
Assess breathing effort. If apneic or gasping, begin positive pressure ventilation (PPV). Use appropriate pressure (20-25 cm H2O initially). Monitor chest rise and heart rate response.
⚠️ Common Mistakes to Avoid:
- Inadequate pressure for effective ventilation
- Poor mask seal causing air leak
- Insufficient monitoring of response
💡 Pro Tip:
Ensure good mask seal and adequate chest rise with each breath.
Step 4: Heart Rate Monitoring
Monitor heart rate continuously. Use auscultation, pulse oximeter, or ECG. Heart rate should increase with effective ventilation. If heart rate remains <60 bpm, begin chest compressions.
⚠️ Common Mistakes to Avoid:
- Inadequate heart rate monitoring
- Delayed initiation of chest compressions
- Poor technique in chest compressions
💡 Pro Tip:
Chest compressions should be initiated if heart rate remains <60 bpm despite effective ventilation.
Step 5: Chest Compressions
Begin chest compressions if heart rate <60 bpm despite effective ventilation. Use two-thumb technique. Coordinate compressions with ventilation (3:1 ratio). Monitor heart rate response.
⚠️ Common Mistakes to Avoid:
- Poor coordination between compressions and ventilation
- Inadequate compression depth
- Incorrect hand position
💡 Pro Tip:
Use two-thumb technique with hands encircling the chest for optimal compressions.
Step 6: Medication Administration
If heart rate remains <60 bpm despite effective ventilation and chest compressions, administer epinephrine. Use umbilical vein or endotracheal route. Dose: 0.01-0.03 mg/kg IV.
⚠️ Common Mistakes to Avoid:
- Incorrect epinephrine dose
- Wrong route of administration
- Delayed medication administration
💡 Pro Tip:
Epinephrine should be given IV when possible, with endotracheal route as backup.
Step 7: Post-Resuscitation Care
Once heart rate >100 bpm and breathing established, provide post-resuscitation care. Monitor vital signs, oxygen saturation, and neurological status. Document all interventions.
⚠️ Common Mistakes to Avoid:
- Inadequate post-resuscitation monitoring
- Poor documentation of events
- Insufficient family communication
💡 Pro Tip:
Document all interventions and responses for quality improvement and family communication.
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Post-procedure Care
Post-resuscitation care involves continuous monitoring of vital signs, oxygen saturation, and neurological status. Document all interventions and responses. Provide family support and education. Arrange appropriate level of care based on resuscitation needs.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Hypothermia | Common | Temperature <36.5°C, poor perfusion | Increase warming, monitor temperature | Preheated warmer, immediate drying |
| Pneumothorax | 2-5% | Decreased breath sounds, chest asymmetry | Needle decompression, chest tube | Appropriate ventilation pressure |
| Intracranial hemorrhage | 1-3% | Bulging fontanelle, seizures | Neurological monitoring, imaging | Gentle handling, avoid excessive pressure |
| Retinopathy of prematurity | Variable | Retinal vascular changes | Ophthalmological monitoring | Appropriate oxygen saturation targets |
| Bronchopulmonary dysplasia | 10-20% in preterm | Chronic respiratory disease | Respiratory support, monitoring | Gentle ventilation, appropriate pressures |
Clinical Pearls
Remember the golden minute - most newborns respond within 60 seconds of appropriate intervention.
Always ensure good mask seal and adequate chest rise with each breath.
Chest compressions should be initiated if heart rate remains <60 bpm despite effective ventilation.
Use two-thumb technique with hands encircling the chest for optimal compressions.
Document all interventions and responses for quality improvement and family communication.
Maintain normothermia throughout resuscitation to improve outcomes.
Avoid deep suctioning as it can cause bradycardia and apnea.