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Resuscitation of A Newborn

Table: Neonatal resuscitation supplies and equipment

  1. Suction equipment
    1. Meconium aspirator
    2. Mechanical suction
    3. Suction catheters 10, 12 or 14 F
  2. Bag and mask equipment (AMBU Bag / Self inflating Bags)
    1. Neonatal resuscitation bags (Self-inflating)
    2. Face-masks (for both term and preterm babies)
    3. Oxygen with flow meter and tubing
  3. Intubation equipment
    1. Laryngoscope with straight blades no. 0 (preterm) and no. 1 (term)
    2. Extra bulbs and batteries (for laryngoscope)
    3. Endotracheal tubes 2.5, 3.0, 3.5 and 4.0 mm ID (internal diameter)
    4. Stylet
  4. Medications
    1. Epinephrine
    2. Normal saline or Ringer lactate solution
    3. Naloxone hydrochloride
    4. Sterile water
  5. Miscellaneous
    1. Stop-watch
    2. Linen, shoulder roll, gauze
    3. Radiant warmer
    4. Stethoscope
    5. Adhesive tape, scissors
    6. Syringes 1, 2, 5, 10, 20, 50 mL
    7. Feeding tube 6F
    8. Umbilical catheters 3.5, 5F
    9. Three way stopcocks
    10. Gloves

APGAR score




Respiratory efforts:


slow, irregular

good, crying



< 100

> 100


Blue or pale

Body pink,



Extremity blue



Muscle tone:


some flexion

actively moving the extremities

Reflex stimulation:

No response


Cries, coughs, Sneezes


Extra Edge: Apgar score is taken at 1, 5 & 10 minutes of birth
Apgar score at 5 minutes is more important than one minute score.
As at 5 minutes < 4 → is very low
                        4-8 → is moderately low
                        > 8 → is normal

  1. Management of infant born through MSL
    1. Vigorous baby
      1. Hr > 100/min
      2. Strong respiratory efforts
      3. Good muscle tone
        Absence of any single sign would mean a non-vigorous baby
    2. Non vigorous babies
      1. Place the baby under radiant warmer

The trachea should be then intubated & meconium suctioned from lower airways. (Intratracheal suctioning with negative pressure)

TABC of Resuscitation


The components of the neonatal resuscitation procedure related to the TABC of resuscitation are shown here:

  1. T-Temperature: Provide warmth, dry the baby and remove the wet linen.
  2. A-Airway: Position the infant, clear the airway (wipe baby's mouth and nose or suction mouth, nose and in some instances, the trachea). If necessary, insert an endotracheal (ET) tube to ensure an open airway. B-Breathing: Tactile stimulation to initiate respirations, positive-pressure breaths using either bag and mask or bag and ET tube when necessary.
  3. C-Circulation: Stimulate and maintain the circulation of blood with chest compressions and medications as indicated.
    1. If the infant is apneic or gasping
    2. Resp is spontaneous but HR< 100.
  2. C/I:
    1. Meconium stained with depressed baby
    2. Suspected diaphragmatic hernia
    3. Put an intragastric tube: - If required > 2 min
  3. Chest compressions:
    1. if after 30 seconds of PPV
    2. HR < 60/min
  4. Chest compression: Two thumb technique – better than two finger technique.
    1. Two finger tech
       Two thumb tech
    2. Lower third of the sternum.
    3. 1/3 of AP diameter
      ½ of ¾ inch
    4. Compression : Ventilation
                       3 : 1
    5. Tip of fingers should remain in contact with the compression area
  5. Endotracheal Intubation:
    1. When prolonged PPV is required
    2. When bag and mask is ineffective
    3. When tracheal suction is required
    4. When diaphragmatic hernia is suspected
  6. Def.: Birth asphyxia
    1. If baby is apneic
    2. Apgar score < 3 at 5 m in - Severe
    3. 4-6 at 5 min - Moderate
    4. Cord blood pH < 7.0

New Recommendations of Neonatal Resusc1tation

  1. Meconium Stained Amnionic fluid:
    1. Intrapartum suctioning from mouth pharynx and nose is not recommended
    2. Direct laryngoscopy and intubation only if baby is not vigorous (any of three conditions below)
      1. Infant has depressed or absent respiration
      2. Decreased muscle tone
      3. Heart rate < 100
  2. Chest Compression:
    1. If the HR is absent or remains < 60 despite adequate ventilation for 3o sec.
    2. Thumbs: encircling technique is preferred to 2 finger on sternum method.
    3. Compression: Relative rather than absolute- approx 1/3 of the AP diameter.
  3. Medications:
    1. Adrenaline: Indicated when HR < 60 after a minimum of 30 sec of adequate ventilation and chest
    2. compression
    3. Volume expanders: Fluid of choice—NS/RL not albumin
    4. High dose adrenaline is not recommendable

Naloxone should not be given intra tracheally.


Table: Follow up action for absence of chest rise.


Condition corrected

Reapply mask

Inadequate seal

Reposition the infant’s head

Blocked airway

Check for secretions; suction, if present

Blocked airway

Ventilate with mouth slightly open

Blocked airway

Increase pressure slightly

Inadequate pressure


Follow up action for heart rate response

Heart rate


Above 100

If spontaneous respiration is present, discontinue ventilation gradually. Provide tactile stimulation, and monitor heart rate, respiration and color.

60 to 100

Continue ventilation

Below 60

Continue to ventilate; start chest compressions.

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