Chapter 168. Newborn Resuscitation

See Figure 168-1.

• Start stabilization (dry, warm, position, assess the airway, stimulate to breathe):
  • Routine intrapartum oropharyngeal and nasopharyngeal suctioning for infants born with clear or meconium-stained amniotic fluid is no longer recommended
  • Cord clamping should be delayed for at least 1 minute in babies who do not require resuscitation. Evidence is insufficient to recommend a time for clamping in those who require resuscitation
  • Evaluate heart rate and respirations to determine next step in resuscitation
• Ventilation—spontaneously breathing preterm infants who have respiratory distress may be supported with CPAP or intubation and mechanical ventilation
  • Assisted ventilation rates of 40–60 bpm have been used, although efficacy has not been reviewed. Adequate ventilation is assessed by prompt improvement of heart rate
  • Use pulse oximetry to evaluate oxygenation because assessment of color is unreliable
  • Supplementary oxygen should be regulated by blending oxygen and air, and the concentration delivered should be guided by oximetry
  • The available evidence does not support or refute the routine endotracheal suctioning of infants born through meconium-stained amniotic fluid, even when the newborn is depressed
• Chest compressions (Figure 168-2)—if HR <60, start chest compressions:
  • 3:1 compression to ventilation ratio
  • Two thumb-encircling hands method
  • Centered over the lower third of the sternum
  • Compression depth one third the anterior–posterior diameter
• Medications—naloxone is not recommended as part of the initial resuscitation for newborns with respiratory depression in the delivery room
• Volume expansion—early volume replacement with crystalloid or red cells is indicated for babies with blood loss who are not responding to resuscitation. While volume administration in the infant with no blood loss who is refractory to conventional resuscitation is not routinely performed, a trial of volume administration may be considered in these babies because blood loss may be occult
• Therapeutic hypothermia should be considered for infants born at term or near term with evolving moderate to severe hypoxic-ischemic encephalopathy, with protocol and follow-up coordinated through a regional perinatal system
• It is appropriate to consider discontinuing resuscitation if there has been no detectable heart rate for 10 minutes. Multiple factors should be taken into account to decide whether to continue beyond 10 minutes