II. Background

  1. Performed immediately after delivery for all newborns
  2. Entire initial assessment should not exceed 30 seconds
  3. Newborns need only these steps in 90% of cases

III. Protocol

  1. Place infant under radiant heater
  2. Meconium suctioning via Endotracheal Tube (if needed)
    1. Indications (perform before too many respirations)
      1. Thick meconium stained and
      2. Not vigorous (depressed tone, respirations, pulse)
    2. Technique
      1. Cords visualized with Laryngoscope
      2. Clear mouth with 12-14F suction catheter if needed
      3. Insert ET Tube to below cords
      4. Suction with meconium aspirator as the ET Tube is withdrawn
      5. Repeat insertion as needed to clear below cords
      6. Consider leaving the Endotracheal Tube in place if Heart Rate is dropping below 60
  3. Suction mouth, then nose
    1. Suctioning at perineum with delivery of head is no longer recommended as of 2010 (even for thick meconium)
  4. Dry thoroughly
  5. Remove wet linen
  6. Position with slight neck extension (sniffing position)
    1. Consider small rolled blanket under Shoulders
  7. Provide tactile stimulation
    1. Drying and suctioning are usually sufficient
    2. Additional measures
      1. Flick soles of feet
      2. Gently rub back
    3. Do not delay Resuscitation for continued apnea
      1. Response to stimulation should be within seconds
      2. Immediately move to next step if no response
      3. Secondary apnea will not respond to stimulation
    4. Avoid harmful measures
      1. Do not shake, slap or squeeze infant
      2. Do not forcefully flex thighs onto Abdomen
  8. Assess need for further Resuscitation
    1. Infant not breathing or Heart Rate less than 100
      1. Resuscitation: See subsequent assessment below
    2. Central Cyanosis
      1. Administer free-flow oxygen starting at 21% and titrating up
      2. See Neonatal Perfusion Assessment
    3. No identified problems
      1. Baby may be placed on mothers chest and observed

V. References

  1. Bhalla (2014) Crit Dec Emerg Med 28(1): 2-11
  2. Kattwinkel (2000) Neonatal Resuscitation, AAP-AHA
  3. Kattwinkel (2010) Neonatal Resuscitation, AAP-AHA
  4. Raghuveer (2011) Am Fam Physician 83(8): 911-8 [PubMed]

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