11: Assessment of the Newborn and Neonatal Resuscitation

INTRODUCTION

Anesthesiologists are often involved in various aspects of care on a labor and delivery unit. However, the anesthesiologist’s primary responsibility is to provide care to the mother, particularly during an anesthetic for cesarean or complicated vaginal delivery. Thus, on a labor and delivery unit, at least one person other than the members of surgical team should be qualified to provide neonatal resuscitation and be immediately available to assume responsibility for resuscitation of the depressed newborn.¹ Because the primary responsibility of the obstetrician and anesthesiologist is care of the mother, these individuals may not be able to shift care from the mother to the newborn. For the anesthesiologist, this may even be the case when the patient has a neuraxial anesthetic that is functioning adequately.¹ However, the anesthesiologist should offer assistance in situations including management of a difficult neonatal airway or during the absence of a designated qualified individual for resuscitation. The benefit to the child must be weighed against the risk to the mother in these special circumstances.² In the majority of situations, after assisted vaginal delivery or cesarean section, the mother is stable; therefore, if there is a need for neonatal resuscitation, the anesthesiologist should be available to help. In certain institutions, there may be an anesthesia care team caring for the mother (eg, an attending and a resident or fellow, or a nurse anesthetist). If the mother is stable, one member of this team may be free to help care for the neonate. It is important to keep in mind that soon after delivery the mother is undergoing tremendous physiologic changes and maternal status may change quickly. It still remains a judgment call for the anesthesiologist in charge to determine where his or her priorities lie—caring for either the mother or the newborn or caring for both.

History

Neonatal resuscitation has come a long way since the days of swinging the infant upside down and dilating the rectum with a raven’s beak back in the 19th century.³ Figure 11-1 is an illustration, reputedly of Dr. Bernhard Schultze himself, demonstrating the Schultze method of neonatal resuscitation.

There are approximately 4 million neonatal deaths per year worldwide, and 23% of these are the result of birth asphyxia.⁴ In an attempt to improve outcome, the Neonatal Resuscitation Program (NRP) was developed by a joint American Academy of Pediatrics (AAP) and American Heart Association (AHA) committee, which produced its first textbook in 1987.⁵ The NRP was initiated to ensure that at least one person trained in neonatal resuscitation be present in every hospital delivery, and it is designed to be uniform for all personnel who attend deliveries, ...