1. Neonatal Resuscitation
Joseph Gilhooly, MD
Doernbecher Children’s Hospital

2. NRP 2001

3. Resuscitation Algorithm: 2001

4. Why we need to resuscitate:
pH 7.30
pH 7.00
pH 6.80

5. How often do we use our resuscitation skills?

6. Suction Equipment
Warmer & Blankets
Bag, Mask, & Oxygen
Laryngoscope and ETT Tube

7. Universal Precautions

8. Assessment: Then
Appearance
Pulse
Grimace
Activity
Respirations

9. Assessment: Now Clear of Meconium? Breathing or Crying? Breathing
Physiologic Parameters (Apgar’s best)
Questions to ask yourself
Clear of Meconium?
Breathing or Crying?
Good Muscle tone?
Color Pink?
Term Gestation?
Breathing
Heart Rate
Color

10. Initial Management: For all deliveries
Provide warmth
Position and Clear Airway
Dry
Give Oxygen (as necessary)

11. Providing Warmth: The cycle of hypothermia
Acidosis
Pulmonary Vasoconstriction
Anaerobic metabolism
Pulmonary Hypertension
Tissue hypoxia
Right to left shunting
Hypoxemia

12. Positioning: Sniffing

13. The “Trusty” Bulb Syringe

14. Clear of Meconium?

15. Color pink?

16. Pulse Oximetry: Resuscitation monitor
Not affected by acrocyanosis
Be patient and get a reading
If baby in shock, get central IV access

17. Breathing or Crying? Indications for PPV Apnea or gasping
Heart rate <100 even if breathing
Persistent central cyanosis (saturation <90%) despite 100% free-flow oxygen

18. Self-Inflating Bag Pressure manometer attaches O2 Reservoir
PEEP valve port
ml Bag size

19. Neopuff CPAP Pressure limited ventilation with PEEP Blended oxygen
Eliminates variability associated with bag ventilation

20. Masks
Smallest sizes are for preterm infants

21. Make sure the airway is clear
Lift the baby’s jaw into the mask
Keep the mouth slightly open
Rate 40-60

22. Indications for Intubation
Meconium and baby is not vigorous
PPV by bag-mask does not result in good chest rise
PPV needed beyond a few minutes
Chest compressions necessary
Route to administer epinephrine
Special indications: Prematurity, CDH

23. Miller 0
Miller 1

24. >2000 gm
3.5
3.0 gm
2.5
<1000 gm
Stylet

25. Intubation Technique

26. Lip reference mark: (6 + weight in kilos) cm
9-10 cm at the lip for this term infant

27. Indications for Compressions
Heart rate <60 bpm after 30sec of PPV
Coordinate with ventilation
4 events in 2 seconds
90 compressions and 30 breaths per minute
One and Two and Three and Breathe
2 seconds

28. 2 thumb technique preferred
Compressions
2 thumb technique preferred

29. Medications: Epinephrine
Indication: Heart rate <60 after 30 sec of coordinated ventilation and compressions
1:10,000 (0.1mg/ml)
Route: ETT or IV
ml/kg
1ml Term
0.5ml Preterm
0.25ml Extreme preterm

30. Extended Algorithm Endotracheal Intubation if not already accomplished
Establish IV access with UVC
Stat CXR
Discontinue efforts if no heart rate after 15 minutes

31. IV Access: “Low” UVC

32. Volume
Indication: No response to resuscitation and evidence of blood loss
Normal Saline
Ringers or Blood as alternatives
10 ml/kg, may repeat
Route: IV (Umbilical vein)

33. Sodium Bicarbonate
Indication: Documented or assumed metabolic acidosis
Concentration: 4.2% NaHCO3 (0.5meq/ml)
Dose: 2meq/kg
Route: IV (Umbilical vein)

34. Naloxone (Narcan)
Indication: Severe respiratory depression after PPV has restored a normal HR and color and…
History of maternal narcotic administration within the past 4 hours
Dose: 0.1mg/kg of 1mg/ml solution
Route: ETT, IV, IM, SQ

35. Hypoglycemia
Blood Glucose <45-60
5cc/k D10W
Route IV