Neonatal resuscitation

Use this note for the non-delivery related resuscitation of the newborn; see newborn resuscitation for immediate after-delivery resuscitation. See newborn critical care quick reference for vital signs and drug doses, and equipment sizes.


  • Neonate <1mo age

Clinical Features

Differential Diagnosis

Sick Neonate




  • Blood glucose (stat)
  • Sepsis workup
  • Blood gas
  • ECG
    • Treatable conditions include SVT
  • Ammonia, pyruvate and lactate to rule in inborn errors of metabolism
    • Need to look up values for neonate. Ammonia is high as liver is immature (i.e. that's why neonates are jaundice). Ammonia > 200 requires dialysis


If hypoxic or evidence of CHF assume CHD

  • CHF in neonate = hepatomegaly, wheezing, gallop
  • if unclear, do Hyperoxia test
    • place infant on 100% O2 for 10 minutes
    • check ABG, if O2<100 torr, highly predictive of CHD
    • some use Pulse Ox <95%, less sensitive
  • Abdominal xrays may help rule in intestinal disaster early

Pediatric Hypoglycemia Dextrose Chart

Category Age Glucose Treatment Initial IV Bolus Maintenance Dose
Neonatal <2mo <40 D10W 2.5-5 mL/kg 6 mL/kg/h
Pediatric 2mo-8yrs <60 D25W 2 mL/kg


  • 6 mL/kg/h for first 10 kg
  • + 3 mL/kg/h for 11–20 kg
  • + 1.5 mL/kg/h for each additional kg >20 kg
Adult >8yrs <70 D50W 50mL (1 amp) OR 1 mL/kg
  • Consider diluting the D25W or D50W bolus, with NS 1-to-1, as those concentrations may be sclerosing to veins
  • Recheck 5 minutes after dose and repeat dose if low.
  • Consider glucagon IM/SQ if IV access is not readily available


Empiric Treatment for Unstable Neonates

Medication/Intervention Indication Dose/Size (for neonate)
Glucose Hypoglycemia 5–10 mL/kg of 10% dextrose in water IV
3% normal saline Symptomatic hyponatremia 3–5 mL/kg bolus IV
Calcium Hypocalcemia 50–100 milligrams/kg calcium gluconate or 20 milligrams/kg calcium chloride IV
Cefotaxime Infection 50 milligrams/kg IV
Ampicillin Infection 50 milligrams/kg IV
Gentamicin Infection 2.5 milligrams/kg IV
Packed red blood cells Anemia 10 mL/kg IV
Normal saline Hypotension, dehydration 5-10 mL/kg IV aliquots (up to 60-80 mL/kg)
10% dextrose in one fourth normal saline Metabolic disease 1.5 maintenance (6 mL/kg/h for the first 10 kg)
Endotracheal intubation Hypoventilation or frequent apnea <3mm for preemie; 3mm for term neonate, 3.5mm for older infant; cuffed tube prefered if not premature

See Also

Pediatric Critical Care

External Links


  1. Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.