Key things to
do during first 5 minutes of neonatal resuscitation
born precipitously in ED, always ask: 1) Term? 2) Good tone? 3)
Breathing or crying?
If yes to
all 3Qs, consider delaying cord clamping and hand baby to mother
for skin-to-skin contact while keeping baby warm and dry.
cord should be delayed 30-60 sec unless child requires immediate
with less IVH, NEC, better BPs and blood volume, but a/w more
If no to any
of Qs, cut cord and begin resuscitation by:
to warmer (make sure it’s on!, plastic bag from neck
down) goal temp 36.5-37.5
syringe suction to clear secretions,
stimulate. Ventilate/oxygenate as needed.
temp monitor on liver – largest organ provides most consistent
measurement. Hypothermia increases risk of intraventricular
hemorrhage, respiratory issues, hypoglycemia, and late onset sepsis.
aspiration no longer empirically intubated, treat similar to other
babies with stimulation, suctioning, PPV as needed. Immediate
intubation thought to delay resuscitation
Resuscitating a neonate: HR, RR, Pox
Detecting HR difficult, 3 lead ECG best, umbilical cord stethoscope
alternate but not as accurate
bradycardic HR <60, start chest compressions, thumb encircling
chest wall, 3:1.
already done, intubate baby
concentration, dose 0.01 mg to 0.03 mg/kg IV, or 0.05 to 0.1 mg/kg
ox – low oxygen sat is normal in first few minutes of life.
Increases by 5% every minute of life. Place monitor on R palm/wrist
for pre-ductal measurement, reflects blood that is going to the
preductal (right hand) O2 Sat
with room air (FiO2 21%) initially
supplemental O2 – increase FiO2 if not achieving normal saturation
or has a HR<100.
BVM to RR 40-60 for 30 sec, CPAP
If need for
CPR, then intubated baby
ETT = [age/4+4]
<28 wks 2.5
28-34 wks 3.0
34-38 wks 3.5
>38 wks 3.5 to 4
Depth 3xETT size to lip
vein catheter: (PED Rm 4 has BOA cart w/ UVC kit)
2 eyes = umbilical arteries, flat mouth = vein. Insert catheter
into vein 2-4cm until blood flow achieved
DIY UVC kit
– 5 Fr feeding tube, 11 blade scalpel, hemostats, forceps, 3 way
stop cock, 10ml flush, umbilical tie
Why does baby
or volume? Give transfusion or IVF bolus as indicated, 10ml/kg,
rupture or abruption?
with umbilical cord?
2ml/kg of D10 as initial bolus, then D10W maintenance IVF at
80ml/kg per day.