• Skip to content
  • Skip to primary sidebar
  • Collections
  • ECG Library
  • Top 100
  • PART ONE
  • CASES
  • CCC
  • Tox Library

Life in the Fast Lane • LITFL • Medical Blog

Emergency medicine and critical care medical education blog

Critical Care Compendium | Newborn Resuscitation

Newborn Resuscitation

by Chris Nickson, Last updated August 29, 2017

OVERVIEW

Priorities:

  • correction of hypoxia (most common cause of neonatal arrest)
  • decreased risk of meconium aspiration
  • support circulation

INITIAL ACTIONS

  • Declare emergency
  • Call for help (neonatal/paediatric registrar or consultant)
  • Move baby to resuscitare
  • Stimulate baby by drying

AIRWAY

  • open airway and assess for patency (suction if required)
  • if this baby doesn’t respond quickly will probably need intubation (appropriate size for term neonate = 3.5, intubate and place tip of ETT just beyond cords – ensure adequately ventilating both lungs, length @ lips should be 9cm)
  • if meconium soiling airway intubate and suction down ETT before ventilating

BREATHING

  • administer 100% O2 via bag-mask (5 effective breaths)
  • provide PEEP
  • watch for spontaneous breathing
  • if no respiratory effort give IPPV until HR >100

CIRCULATION

  • pulse = 60/min -> institute chest compression (3:1) @ rate of 100/min with thumbs around chest
  • begin to obtain IV access by placing an IV cannula into the umbilical vein or interossous needle insertion
  • administer adrenaline (0.1mL/kg o 1:10,000 – the average full term neonate = 3.5kg thus administer 0.35mL IV or 3.5mL into trachea)
  • give an IV normal saline bolus of 70mL (20mL/kg)
  • attach ECG if not responding ? shockable rhythm

DISABILITY

  • send bloods for cord pH and ABG
  • check glucose (dextrose 10% 5mL/kg)
  • consider naloxone 200mcg IM
  • consider NaHCO3 4.2% 1mmol/kg = 3.5mmoL

EXPOSURE/ ENVIRONMENT/ EVERYTHING ELSE

  • keep warm and dry
  • make sure wet towels are removed quickly and replaced with warm ones
  • Constantly reassess airway, breathing, circulation, disability and exposure
  • Transfer to neonatal unit for ongoing assessment and treatment

Last update: [last-modified]

Share this:

  • Facebook
  • LinkedIn
  • Twitter

About Chris Nickson

FCICM FACEM BSc(Hons) BHB MBChB MClinEpid(ClinTox) DipPaeds DTM&H GCertClinSim

Chris is an Intensivist at the Alfred ICU in Melbourne and is an Adjunct Clinical Associate Professor at Monash University. He is also the Innovation Lead for the Australian Centre for Health Innovation and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia's Northern Territory, Perth and Melbourne. He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. He coordinates the Alfred ICU's education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the 'Critically Ill Airway' course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of Lifeinthefastlane.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of two amazing children. On Twitter, he is @precordialthump.

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

All LITFL posts by EMAIL or RSS

LITFL Weekly review by EMAIL or RSS

Frivolous Friday Five by EMAIL or RSS

Copyright © 2007 - 2019 · Powered by vocortex and iSimulate

We use cookies to understand site usage and to improve the content and offerings on our sites. If you continue using our website, we'll assume that you are happy to receive all cookies on this website.