Resuscitation (Neonatal)

Principles of Resuscitation

Thermal Regulation

• Place newborn in neutral thermal environment even before initiate ABCs
• Gently dry newborn with warm towel

Airway

• Optimize
  • Position head in sniffing position
  • Suction nose and mouth
• Intubate
  • Indicated if pt is poorly responsive or fails BVM
  • If have time precut ET tube at 13cm mark
  • Lip placement = 6 + wt (kg)
  • After intubation suction trachea to prevent aspiration (if +meconium)

Tube Size / age / wt	Blade	Suction Catheter
2.5 / <28 / <1000	Miller 0	5F or 6F
3.0 / 28-34 / 1000-2000	Miller 0	6F or 8F
3.5 / 34-38 / 2000-3000	Miller 0	8F
3.5-4.0 />38 / >3000	Miller 0-1	8F or 10F

Breathing

• Apneic and/or bradycardic (<100 bpm)
  • Attempt tactile stimulation first
  • If unsuccessful perform BMV at 40-60 breaths/min
  • After intubation use:
    • Inflation pressure ~ 20

Circulation

• CPR
  • Begin if despite assisted ventilation x30s HR still <60
  • 3 compressions:1 breath (total 90 compresions:30 breaths per min)

Vascular Access

• Umbilical vein is site of choice

Volume Expansion

• NS 10-20mL/kg IV over 5-10min
• O Rh-negative blood

Medications

• Epinephrine
  • Indicated for aystole or HR < 60 despite CPR >30s
  • 0.01-0.03mg/kg IVP q3-5min
• Sodium Bicarbonate
  • Helps to counteract negative inotropy/pulm HTN caused by acidosis
  • Only give once adequate ventilation is established
  • 1-2 mEq/kg of 4.2% solution (2-4 mL/kg)
• Naloxone
  • Give if persistent resp depression AND maternal narcotics w/in 4hr
  • 0.1mg/kg IV

Special Problems

Cyanosis

• Must distinguish between central and peripheral
• Consider prostaglandin E1 0.05-0.1 mcg/kg/min for cyanotic heart dz

Pneumothorax

• Tension PTX is highly related to subsequent ICH
  • Place 18-20ga catheter into 4th IC in ant axillarly line

Hypoglycemia

• <30-35 in preterm newborn
• <35-40 in term newborn
• Treatment
  • D10W 2mL/kg IV

Congenital Diaphragmatic Hernia

• Persistent respiratory distress w/ "seesaw" pattern
• Treat via immediate intubation, OG tube placement
  • Use lowest peak insp presure that allows for adequate chest rise

Withholding Resuscitation

• Consider if:
  • <22wk or <400g
  • No signs of life after 10min of CPR

See Also

Pediatric Advanced Life Support (PALS)

Source

Tintinalli