Notes – Neonatal Resuscitation

Neonatal Resuscitation

Patient Safety Considerations

  1. Hypothermia is common in newborns and worsens outcomes of nearly all post-natal complications
    1. Ensure heat retention by drying the infant thoroughly, covering the head, and wrapping the baby in dry cloth
    2. When it does not encumber necessary assessment or required interventions, “kangaroo care” (i.e. placing the infant skin-to-skin directly against mother’s chest and wrapping them together) is an effective warming technique
    3. Newborn infants are prone to hypothermia which may lead to hypoglycemia, hypoxia and lethargy. Aggressive warming techniques should be initiated including drying, swaddling, and warm blankets covering body and head. Check blood glucose and follow Hypoglycemia guideline as appropriate.
  2. During transport, neonate should be appropriately secured in seat or isolette and mother should be appropriately secured

Notes/Educational Pearls

Key Considerations

  1. Approximately 10% of newly born infants require some assistance to begin breathing
  2. Deliveries complicated by maternal bleeding (placenta previa, vas previa, or placental abruption) place the infant at risk for hypovolemia secondary to blood loss
  3. Low birth weight infants are at high risk for hypothermia due to heat loss
  4. If pulse oximetry is used as an adjunct, the preferred placement place of the probe is the right arm, preferably wrist or medial surface of the palm. Normalization of blood oxygen levels (SaO2 85-95%) will not be achieved until approximately 10 minutes following birth
  5. Both hypoxia and excess oxygen administration can result in harm to the infant. If prolonged oxygen use is required, titrate to maintain an oxygen saturation of 85-95%
  6. While not ideal, a larger facemask than indicated for patient size may be used to provide bag-valve-mask ventilation if an appropriately sized mask is not available – avoid pressure over the eyes as this may result in bradycardia
  7. Increase in heart rate is the most reliable indicator of effective resuscitative efforts
  8. A multiple gestation delivery may require additional resources and/or providers
  9. There is no evidence to support the routine practice of administering sodium bicarbonate for the resuscitation of newborns

Pertinent Assessment Findings

  1. It is difficult to determine gestational age in the field – if there is any doubt as to viability, resuscitation efforts should be initiated
  2. Acrocyanosis, a blue discoloration of the distal extremities, is a common finding in the newly born infant transitioning to extrauterine life – this must be differentiated from central cyanosis

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914133 – Medical-Newborn/Neonatal Resuscitation

Key Documentation Elements

  • Historical elements
    • Prenatal complications
    • Delivery complications
    • Date and time of birth
    • Estimated gestational age
  • Physical exam findings
    • Heart rate
    • Respiratory rate
    • Respiratory effort
    • Appearance
    • APGAR score at 1 and 5 minutes

Performance Measures

  • Prehospital on-scene time
  • Call time for additional resources
  • Arrival time of additional unit
  • Time to initiation of interventions
  • Use of oxygen during resuscitation
  • Presence of advanced life support (ALS) versus basic life support (BLS) providers
  • ROSC and/or normalization of heart rate
  • Length of stay in neonatal intensive care unit
  • Length of stay in newborn nursery
  • Length of stay in hospital
  • Knowledge retention of prehospital providers
  • Number of advanced airway attempts
  • Mortality

References

  1. Stallard T, Burns B. Emergency delivery and perimortem C-section. Emerg Med Clin N Am. 2003;21:679-93.
  2. WHO, United Nations Population Fund, UNICEF. Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice (3rd edition). Geneva, Switzeralnd: WHO Press; 2015.