Resuscitation of The Newborn Baby

The goal of resuscitation is :-
-To prevent morbidity & mortality associated with
hypoxic-ischemic tissue injury ( brain, heart,
kidney), this can be achieved if adequate
spontaneous respiration and sufficient cardiac
output can be re established early on.
Although the Apgar score is helpful in evaluating patients in need of attention, infants who are born limp, cyanotic, apneic, or pulseless require immediate resuscitation before assignment of the Apgar score.
Rapid and appropriate resuscitative efforts improve the likelihood of preventing brain damage and achieving a successful outcome.

About 5-10% of newborn babies require active

intervention to establish normal cardiorespiratory
function.

1- First of all the asphyxiated newborn baby should

be put on a resuscitation trolley where the baby put
under a radiant heater to avoid hypothermia then
drying up of the baby, the head is positioned down
& slightly extended, the airway is cleared by
suctioning, and also gentle tactile stimulation
provided (slapping the foot or rubbing of the
back).

If spontaneous respiration started and the cardiac

output improved where the color of the baby
becoming pink, then there is no need now to go
onto further steps of resuscitation, but if these
measures fails to improve the condition of the baby
and the heart rate is < 100 /min so we need:-

2- Positive pressure ventilation with a 100% oxygen

is given through a tightly fitted mask & bag for 15-
30 sec, subsequent breaths are given at a rate of
40-60 /min with pressure of 15-20 cm water.

Successful ventilation is determined by good chest
rise symmetric breath sounds, improved pink color,
heart rate of >100 /min, spontaneous respiration
and improved tone. If no response within
15-30 sec. the next step is:-

Ambu bag

Traditionally, the inspired gas for neonatal
resuscitation has been 100% oxygen. Resuscitation
with room air (or 30%) is equally effective and
may reduce the risk of hyperoxia, which is associated
with decreased cerebral blood flow and generation
of oxygen free radicals. Currently 100% O2 is
recommended. Room air (or 30%) may become the
preferred initial gas for neonatal
resuscitation in the future.

3- Insert an endotracheal tube and start to push an

oxygen through the tube by an ambu bag, if after
15-30 sec of doing that & the baby does not
improve:
(no spontaneous respiration, heart rate
is < 100/min, no improvement in the
color of the baby, so the next step is:-

4- Starting chest compression (cardiac compression

to improve circulation) the compression is exerted
to the lower third of the sternum at a rate of 120
per min. the ratio of compression to ventilation is
3:1 simultaneously the color, the heart rate the
respiration and muscle tone should be assessed, if
the baby did not respond after 15- 30 sec of chest
compression & oxygen supply through
an endotracheal tube then:-

5- An intravenous drugs are used after an insertion of

an intravenous (usually umbilical) catheter and as
follows:-
- Epinephrine 1/10000 (0.1-0.3) ml/kg
IV or intratracheal is given for asystole or for
failure to respond to 30 sec of combined
resuscitation and the heart rate is < 60/min, this
can be repeated every 5 min .

- Volume expanders 10 - 20 ml/kg of (normal saline,

blood, 5% albumine, or ringers solution) should be
given for hypovolemia,pallor,E.M dissociation
(weak pulses with norml heart rate), history of
blood loss, suspicion of septic shock, hypotension
or in poor response to resuscitation.

- Sodium bicarbonate (1-2meq/kg) should be given

slowly in case of metabolic acidosis and
resuscitation is prolonged.
- Calcium gluconate (2-4 ml/kg of 10% solution) if
there is evidence of hypocalcemia.

- Naloxone given in a dose of 0.1 mg/ kg repeated as

needed when there is CNS depression due to
maternal narcotic analgesic administration during
labor which will results in respiratory depression &
failure to initiate spontaneous respiration.

- Dopamine or dobutamine may be given in a dose of

5-20 microgram / kg/ min. this drug may be used in
severe asphyxia when there is depressed myocardial
function.

Poor response to ventilation during resuscitation

may be due to:-

1.loosely fitted mask.
2.Poor positioning of the endotracheal tube.
3.Intraesophageal intubation.
4. Airway obstruction.
5. Insufficient pressure.
6. Pleural effusions.
7. Pneumothorax.

8. Asystole.

9. Hypovolemia.
10. Diaphragmatic hernia.
11. Prolonged intrauterine asphyxia.