Neonates are defined as being less than 1 month of age. Often times, cardiopulmonary resuscitation is required at birth (Figure 172-1). Upon delivery, neonatal well-being is assessed with the APGAR scoring system (Table 172-1). The APGAR score at 1 and 5 minutes (and then in 5-minute intervals thereafter if needed) may be used to assess resuscitative success. Risk factors that predict need for resuscitative efforts include preterm delivery (<37 weeks) and neonates born to febrile mothers. Causes of cardiopulmonary depression include intraventricular hemorrhage (affecting tonsillar pillars), meconium aspiration, bronchopulmonary dysplasia, and congenital heart disease.
Neonatal resuscitation. (Reproduced with permission from Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S543-S560.)
TABLE 172-1APGAR Score |Favorite Table|Download (.pdf) TABLE 172-1 APGAR Score
|Points ||0 ||1 ||2 |
|Appearance ||Blue or pale all over ||Blue extremities, torso pink ||Pink all over |
|Pulse ||None ||<100 ||>100 |
|Grimace ||No response ||Weak grimace ||Cries |
|Activity ||None ||Flexion of arms ||Arms and legs flexed |
|Respirations ||None ||Weak, irregular or gasping ||Strong cry |
Pulmonary—Neonates have a high oxygen consumption (10 cm3/kg/min) high cardiac output and smaller functional residual capacity (FRC) than older patients, hence even brief periods of apnea are not tolerated well. Oxygen saturation should be monitored with a pulse oximeter placed on the preductal side (generally the right hand). This allows for assessment of blood saturation received by the brain. Postductal saturation may be artificially low if there is retrograde flow through the patent ductus arteriosus, which is not uncommon in the newborn.
Cardiac—Compared to adults, neonatal cardiac output is more heart rate dependent because their cardiac muscles cannot contract further to increase stroke volume (HR = CO × SV). Thus, heart rate is used as a guide to assess neonatal well-being. Unless proven otherwise, bradycardia in the newborn is presumed to be asphyxia.
Thermoregulation—Due to their large surface area, neonates tend to lose heat rapidly. During initial stabilization, neonates need extra measures such as warming of the delivery room (26°C), an exothermic mattress, and radiant heat lamps to ensure normothermia.
KEY COMPONENTS OF NEONATAL RESUSCITATION
If the amniotic fluid in the oral cavity is clear, then suctioning (including bulb syringe) of the airway is only necessary for neonates who are showing signs of obstructed respiration or those who require positive pressure ventilation (PPV). When the amniotic fluid is meconium-stained, then gentle suctioning is recommended. If the patient requires an endotracheal tube, then suction is provided immediately after placement of the endotracheal tube but before PPV is initiated to minimize meconium being pushed ...