5.4. NEONATAL RESUSCITATION

Related Names

None.

Purpose of assistance

1. Provide routine assistance to a newborn baby.
2. Perform neonatal evaluation.
3. Rapid identification of the need for a newborn baby in resuscitation measures.
4. Provision of appropriate interventions to minimize impairment in the newborn.
5. Identification of the need to attract additional resources based on the patient’s condition and/or environmental factors.

Patient description

Inclusion criteria

Newborn children.

Exclusion criteria

Gestational age is less than 20 weeks (usually calculated from the date of the last menstruation). If you have any doubts about the accuracy of gestational age, start resuscitation.

Patient Management

Condition assessment

1. History:

a) date and time of birth;
b) onset of symptoms;
c) the course of the prenatal period (medical care, substance abuse, multiple pregnancy, diseases in the mother);
d) the course of labor (fever in the mother, the presence of meconium waters, loss or entwining of the neck with the umbilical cord, bleeding in the mother);
d) approximate age of the fetus (may be based on the last menstruation).

2. Examination:

a) BH and breathing pattern (strong, weak, absent; regular or irregular);
b) signs of respiratory disorders (grunting, swelling of the wings of the nose, retraction of the walls of the chest, shortness of breath, apnea);
c) Heart rate (fast, slow, absent):

you can use the precordium, umbilical cord or pulse of the brachial artery;
chest auscultation is a more suitable method, since umbilical cord palpation gives less accurate results;
d) muscle tone (weak or strong)
d) skin color/appearance (pallor, acrocyanosis, central cyanosis, normal);
e) APGAR scale (appearance, pulse, facial expression, activity, breathing) – can be calculated if necessary to fill out documentation, but not when adjusting the resuscitation procedure;
f) approximate age of the fetus (born on time, born later than term, prematurely born);
e) the use of pulse oximetry, necessary in the case of a long resuscitation procedure or in the case of oxygen therapy, the purpose of which is to achieve an indicator of 85-95% in 10 minutes.

Treatment and intervention

1. If it is necessary to resuscitate a newborn baby, immediately clamp the umbilical cord in two places and cut it. If there is no need for resuscitation, warm/wipe/stimulate the newborn baby and then cut/clamp the umbilical cord after 60 seconds or after the pulsation in the umbilical cord stops.

2. Warming, wiping, stimulation:

a) wrap the newborn in a dry sheet or thermal blanket to preserve body heat for as long as possible during resuscitation; if possible, keep your head covered;
b) with strong crying, even breathing, normal muscle tone and normal fetal age, put the newborn baby on the mother, providing skin-to-skin contact and cover the baby with a dry sheet.

3. If the child is born prematurely and has weak crying, signs of respiratory failure, poor muscle tone, put the child on his back and raise the head slightly to ensure airway patency – in case of meconium and signs of respiratory distress, sanitize the oral and then nasal cavity.

4. If heart rate is above 100 beats per minute:

a) monitor the presence of central cyanosis – conduct a stream oxygen therapy;
b) monitor the presence of respiratory failure. With shortness of breath or severe respiratory failure

• • • • start ventilation with a bag of AMBU with oxygen (room temperature) with a frequency of 40-60 breath/min;
      • perform tracheal intubation according to local guidelines

5. If heart rate is below 100 beats per minute:

a) start ventilation with a bag of AMBU with oxygen (room temperature) with a frequency of 40-60 breaths/minute:

• • • • the main indicator of ventilation efficiency is improvement of heart rate;
      • the frequency and volume of ventilation may vary, use a minimum frequency and volume that provide movement of the walls of the chest and an increase in heart rate;

b) if there are no improvements for 90 seconds, increase the oxygen concentration to 30% FiO (if there is a mixer), otherwise increase the concentration to 100% until the heart rate normalizes;

c) in case of ineffectiveness of ventilation with an AMBU bag, perform tracheal intubation.

6. If heart rate is below 60 beats per minute:

a) provide adequate ventilation with oxygen therapy and adequate lifting of the chest walls;
b) in case of no improvement within 30 seconds, start chest compression, apply the technique of pressing two thumbs;
c) coordinate pressing with exhalations during ventilation (frequency 3:1, 90 pressing and 30 breathing per minute);
d) perform tracheal intubation (according to local guidelines);
d) enter epinephrine (0.1 mg/ml) 0.01 mg/kg IV or IV (preferred route of administration under conditions of access) or 0.1 mg/kg through the endotracheal tube (in case of inability to access).

7. Check the level of glucose during resuscitation, a history of diabetes in the mother, the presence of concomitant pathology or other contraindications to feeding.

8. Inject 10 mg/kg of normal saline IV or IV with signs of shock or as post-animation therapy.

Safety of the newborn

1. Hypothermia is typical of neonates and may worsen the effects of all postnatal complications:

a) ensure the preservation of heat by wiping the baby dry, as well as covering from head to toe in a dry sheet;
b) in the absence of examination needs or interventions, the “kangaroo method” (that is, place the baby near the mother, providing contact with the skin and covering them both with a blanket) is the best way to warm up;
c) newborn babies are prone to hypothermia, which in turn leads to hypoglycemia, hypoxia and drowsiness. Active warming should include wiping dry and sheltering from head to toe with a warm blanket. Check the glucose level and proceed according to the instruction “Hypoglycemia.”

2. During transportation, the newborn baby must be clearly fixed on the chair or incubator, the mother must also be clearly fixed.

Useful information for training

1. Approximately 10% of all newborns require certain interventions in order to start breathing.
2. Births complicated by bleeding in the mother (placental presentation, vaginal presentation or placental detachment) put the baby at risk of hypovolemia due to blood loss.
3. Newborns with low body weight have a high risk of hypothermia due to heat loss.
4. In the case of pulse oximetry as an auxiliary monitoring, the main location of the sensor is the right hand in the wrist or medial surface of the palm. Normalization of the level of oxygenation (85-95%) occurs only 10 minutes after birth.
5. Hypoxia and excessive ventilation together can cause harm to the newborn. If it is necessary to continue oxygen therapy, maintain the level of oxygenation at the level of 85-95%.
6. Despite the size discrepancy, an oxygen mask for adults can also be used for ventilation with an AMBU bag (if there is no mask of the appropriate size) – however, avoid pressure on the eyeballs, as this can lead to bradycardia.
7. An increase in heart rate is the most reliable indicator of the effectiveness of resuscitation.
8. Childbirth in multiple pregnancies may require additional resources and/or EMF specialists.
9. Evidence supporting the routine use of sodium bicarbonate in neonatal resuscitation is lacking.

Relevant evaluation results

1. In the field, it is difficult to determine the gestational age of the fetus; if there is any doubt about viability, resuscitation measures should be initiated.
2. Acrocyanosis – blue of the distal extremities, is a typical sign in newborns immediately after birth – it must be distinguished from central cyanosis

Key elements of documentation

1. Medical history:

a) complications in the prenatal period;
b) complications during childbirth;
c) date and time of birth;
d) approximate age of the fetus.

2. Physical examination results:

a) Heart rate;
b) DD;
c) qualitative assessment of breathing;
d) appearance;
d) APGAR scores in the first and fifth minutes from birth.

Criteria for the effectiveness of care

1. Time at the scene.
2. Additional resource call time.
3. Arrival time of additional units.
4. Start time of intervention.
5. Use of oxygen during resuscitation.
6. The presence of an expanded complex of resuscitation measures against basic life support measures by EMF workers.
7. Restoration of spontaneous circulation and/or normalization of heart rate.
8. Time spent in the neonatal intensive care unit.
9. Time spent in the maternity ward.
10. Time in hospital.
11. Maintaining the level of knowledge of EMF system specialists.
12. Number of intubation attempts.
13. Mortality.