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Neonatal Resuscitation : Algorithm, Steps, Procedure, & Guidelines

Neonatal Resuscitation (Newborn Resuscitation) : Algorithm, Steps, Procedure, & Guidelines (NRP Guidelines)

Resuscitation Algorithm

  • Term gestation?
  • Breathing or crying?
  • Good muscle tone?

                       ↓Any no

  • Provide warmth
  • Clean the secretions
  • Dry
  • Stimulation*

                   ↓

  • Is heart rate < 100 min?

OR

  • Gasping or apneic?

                        ↓Yes

  • Positive pressure ventilation  PPV* (Bag & Mask)
  • SpO2 monitoring

                   ↓

Heart rate < 100/min?

↓Yes

Ventilation Corrective Steps*

                    ↓

Heart rate < 60/min?

↓Yes

  • Intubate & Start PPV
  • Chest compression
  • Coordination

                    ↓

Heart rate < 60/min?

                         ↓Yes

Drugs

Stimulation

  • Rubbing the back, or
  • Flicking the sole.

Positive Pressure Ventilation (PPV) :

  • Given by Bag & Mask Ventilation (BMV)
  • Bag used in resuscitation: AMBU Bag
  • Capacity of AMBU Bag: 240-750 ml

Contraindications for BMV are

  • Absolute C/I: Congenital diaphragmatic hernia
  • Relative C/I: Tracheoesophageal fistula, Meconium aspiration syndrome (MAS)

Ventilation Corrective Steps

MRSOPA

  • M : Mask to be reapplied
  • R : Reposition head
  • S : Secretion suctioned (Mouth is suctioned first followed by nose) : Trachea is not suctioned.
  • O : Open mouth
  • P : Pressure during PPV to be increased
  • A : Alternate airway to be considered (due to suspected blockage)

Chest Compression

  • Two thumb or Two hand technique (BEST)
  • Two finger or Single hand technique

Coordination

Chest compression : Ventilation :: 3 : 1

e.g. 1 min → 90 compression & 30 ventilation ⇒ Total events 120

Endotracheal intubation

Appropriate endotracheal tube size is

Inner diameter of tube (mm) Weight (g) Gestational age (weeks)
2.5 <1000 <28
3.0 1000-2000 28-34
3.5 2000-3000 34-38
4.0 >3000 >38

Resuscitation in Meconium-Stained Liquor (MSL) Babies

See whether baby is vigorous or not.

  • Heart rate >100/min?
  • Good respiration effort?
  • Good muscle tone?

↓Any NO

  • Non-vigorous baby

Needs Resuscitation

  • No stimulation
  • No oral / pharyngeal suction
  • No tracheal suction
  • No BMV

Only intubation, short PPV & chest compression

  • Drugs

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