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Clamp the cord securely
- For uncompromised term and preterm infants, a delay in cord clamping of at least one minute from the complete delivery of the infant.
- For infants requiring resuscitation, resuscitative intervention remains the immediate priority.
Maintain a normal body temperature
- The temperature of newly born infants is actively maintained between 36.5°C and 37.5°C after birth
- Dry the baby, remove the wet towels and wrap the baby in dry towels.
- Preterm infants are best placed, without drying, into polyethylene wrapping under a radiant heater
Assessing the infant’s condition
- Assess colour, tone, breathing by chest movement, and heart rate regularly every 30 s
- An Apgar score (ranging from 0–10, based upon an assessment of heart rate, respiration, muscle tone, reflex irritability, and colour) at 1 and 5min is calculated and used to assess newborn babies.
- Place the infant on his back with the head in the neutral position
- If the baby is gasping or not breathing adequately by 90sec, open the airway, give 5 inflation breaths (pressures of 30cm water for 2–3sec), preferably using air
- Begin with lower pressures (20–25 cm H2O) in preterm infants
- Use positive end-expiratory pressure (PEEP) of 4–5 cm H2O if possible
- Consider Monitoring Spo2 +/- ECG
- If the heart rate increases, this indicates successful ventilation of the lungs
- If the heart rate increases but the infant does not start breathing for himself(apnoeic), then continue ventilations at a rate of about 30–40 min-1 until the infant starts to breathe on his own.
- If the heart rate does not increase, then the most likely cause is that the lungs have not been inflated- look for chest movement during inflation
If chest not moving:
- Recheck head position
- Consider 2-person airway control and other airway maneuvers
- If the airway is obstructed, consider an oropharyngeal airway, laryngoscopy, and suction.
- Repeat inflation breaths
- Jaw thrust ( 2 person technique)
- Direct Inspection of Oropharynx and Airway Suction
- Guedel Airway
- Treat continuing apnoea with tracheal intubation using a 3mm tube (2.5mm in premature babies). Precede intubation by pre-oxygenation with bag valve mask ventilation for 30sec.
- Checking again that the infant’s head is in the neutral position?
- Is there a problem with face mask leak?
- Do you need jaw thrust or a two-person approach to mask inflation?
- Do you need a longer inflation time? – were the inspiratory phases of your inflation breaths really of 2–3 s duration?
- Is there an obstruction in the oropharynx (laryngoscope and suction)?
- Will an oropharyngeal (Guedel) airway assist?
- Is there a tracheal obstruction?
- If no increase in heart rate (less than 60 min-1) – look for chest movement
- When the chest is moving but the heart remains slow (less than 60 min-1) or absent after 5 effective inflation breaths and 30 seconds of effective ventilation, start chest compressions.
- The ratio of compressions to inflations in newborn resuscitation is 3:1.
- Re-assess infant after every 30 secs (15 cycles)
- Rate approx 100/mins, using two thumbs technique-lower third of the sternum
- If heart rate is not detectable or slow (<60 min –1) consider umbilical venous catheter (UVC) or IO and drugs(ETT-adrenaline can be considered).Remember B.A.D – Bicarbonate/Adrenaline/Dextrose 10%)
- Give adrenaline 10mcg/kg (0.1mL/kg of 1 in 10 000 if there is no initial response. If this is ineffective the dose may be increased to 30 mcg/kg (0.3mL/kg of 1 in 10 000). The tracheal dose is thought to be between 50–100 microgram kg-1
- Give sodium bicarbonate 1–2mmol/kg (2–4mL of 4.2 % solution/kg) when there is no cardiac output despite all resuscitative efforts or in profound or unresponsive bradycardia.
- Hypoglycemia is a potential problem for all newborns and BMG is unreliable when reading <5mmol/L. Take a blood sample to confirm and treat immediately with a bolus of 2.5mL/kg of 10 % glucose.
- In the presence of hypovolaemia, a bolus of 10 mL kg-1 of 0.9% sodium chloride
When to stop resuscitation
- In a newly-born infant with no detectable cardiac activity, and with the cardiac activity that remains undetectable for 10 min, it is appropriate to consider stopping resuscitation.