This document provides guidelines for neonatal resuscitation. It defines neonatal resuscitation as intervention to help a newborn breathe and for its heart to beat after birth. Some key points include identifying infants at high risk for asphyxia, the goals of resuscitation being to minimize heat loss, establish breathing and circulation, and supporting cardiac output. Chest compressions are indicated for heart rates below 60 bpm. The initial assessment of a newborn involves asking if it is term gestation, if the amniotic fluid was clear, and if the newborn is breathing/crying and has good muscle tone.

1. preparedby:
Dr. Ahmed Erhim Omran

2. Objectives
 Definitions of neonatal resuscitations.
 Identify of infants “at risk” for asphyxia
what’s asphyxia .
 Goals of resuscitation.
 WHO IS AT HIGH RISK?
 Describe Resuscitation of newborn:
– Equipment
– Ambo Bag and mask ventilation
– Cardiac compressions
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3. Definition
Neonatal Resuscitation
is intervention after a baby is born to help it
breathe and to help its heart beat.
Before a baby is born, the placenta provides oxygen
and nutrition to the blood and removes carbon
dioxide.
After a baby is born, the lungs provide oxygen to the
blood and remove carbon dioxide.
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4. •The transition from using the placenta to
using the lungs for gas exchange begins
when the umbilical cord is clamped or tied
off, and the baby has its first breath.
•Many babies go through this transition
without needing intervention.
•Some babies need help with establishing
their air flow, breathing, or circulation.

5. ANTICIPATION OF
RESUSCITATION NEED

6. What’s asphyxia?
Asphyxia – it’s a syndrome characterized by
absence of breathing movements but with
presence of heartbeat of fetus.
Classification:
1. Central (suppression of breathing center(
2. Peripheric
3. May be caused by trauma, immaturity of fetus nervous
system, pharmacological depression etc.
4. May be cased by lungs, heart dysfunction or anemia
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7. Symptoms of Asphyxia
Symptoms of asphyxia in a baby at the time of
birth may include:
 Baby is not breathing or breathing is very weak
 Skin color is bluish or pale
 Heart rate is low
 Muscle tone is poor or reflexes are weak
 Too much acid is in the blood (acidosis)
 The amniotic fluid is stained with meconium
 The baby is experiencing seizure
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8. Goals of resuscitation
Minimizing immediate heat loss.
Establishing normal respiration and lung expansion.
Increasing saturation
Supporting adequate cardiac output.
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9. WHO IS AT HIGH RISK?
• Before Delivery
– Maternal causes
– Fetal causes
• During Delivery
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10. MATERNAL CONDITION
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• Age (>40yrs, <16yrs)
• Socioeconomic status (poverty, malnutrition)
• Detrimental habits :
(smoking, drugs, alcohol abuse)

11. Maternal Medical Conditions
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• DM
• HTN
• Chronic heart, lung, or kidney diseases
• Blood disorders (thrombocytopenia, anemia)
• H/O previous stillbirth/early neonatal death
• Antepartum hemorrhage
• Premature rupture of membranes
• Infections, UTIs, GBS carrier
• Placental Anomalies (previa, poly/oligohydramnios)
• Heavy sedation.

12. Fetal Conditions
• Pre/post-maturity
• IUGR
• Macrosomia
• Congenital anomalies
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13. Continue ..
Fetal Conditions
• Hydrops fetalis.
• Abnormalities of presentation (transverse lie, breech)
• Multiple gestation.
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14. During birth
• Prolapsed cord
• Utero-placental bleeding
• Prolonged labour.
• Meconium in the amniotic fluid
• Abnormal fetal heart rate patterns
• Instrumented delivery (forceps, vacuum, or cesarean)
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15. WHO Guidelines
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Anticipate
 Be prepared for every birth by having skill to
resuscitate and by knowing the institutions policy
on resuscitation
 Review the risk factors for birth asphyxia
 Clearly decide on the responsibilities of each
health care provider during resuscitation
 Remember that the mother is also at risk of
complications

16. NECESSARY EQUIPMENT
Laryngoscop ET tubes
Transport incubater
2End tidal co
moniter
Radiant warmer
Oxygen source Ambo bag
low presure suction
maschine,doli’bulb
suction
Infant feeding tube
Stethoscope
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17. Preparation of Equipment
Ensure that radiant warmer on ,warm towel
available,
Turn on oxygen source,
Test the anesthesia Ambo bag for pop off
control & adequate flow.
Laryngoscope light and an appropriate blade.
Appropriate ET tube
Emergency drugs.
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18. DURING DELIVERY
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19. OVERVIEW
 10% of newborns require some assistance
to begin breathing at birth
 <1% require extensive resuscitative
Measures.
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20. 3 QUESTIONS TO ANSWER WITH
YES/NO
 Term gestation?
 Crying or breathing?
 Good muscle tone?
 YES!
• baby does not need resuscitation
• should not be separated from the mother.
• dry, place skin-to-skin with the mother
• cover with dry linen to maintain temperature
• Observe breathing, activity, and color
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21. NO ?
Term gestation?
Crying or breathing?
Good muscle tone?

22. Initial Steps for Neonatal Resuscitation
in Delivery Room
I. Warm & Dry infant
Place infant under radiant heat warmer bed and dry infant.
position the head in a “sniffing” position to open the airway.
stimulate breathing )tactile stimuli(.
II. Initiate ABC
A= Establish airway: position head
in neutral position and bulb suction mouth and nose.
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23. CLEARING THE
AIRWAY

24. Initial Steps for Neonatal Resuscitation
in Delivery Room
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B= Breathing : Ambo Bag & Mask Ventilation or
Ambo Bag & ET tube always with 100% FI.O2
C= Circulation: Assess heart rate by listening to
Apical pulse with stethoscope, pulse in umbilicus,
or brachial pulse.

25. Initial Steps for Neonatal Resuscitation
in Delivery Room
III. Evaluate infant for:
1. Color : central vs. acrocyanosis. If centrally cyanotic give
infant facial oxygen.
2. Signs of Respiratory distress:
a. Tachypnea b. Nasal flaring c. Grunting d. cyanosis
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26. Ambo Bag and Mask Ventilation
in the Newborn
Indications for Ambo bag mask ventilation
a . Apnoea
b. Heart rate less than 100
Contraindications
• Diaphragmatic hernia.
 Indications for intubation
a.Prolonged ambo bag and mask ventilation
b.Ambo Bag and mask is ineffective
c.Tracheal suctioning
 ET tube sizes and correct suction catheter sizes.
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27. Chest Compressions
Indications: If after 15-30 seconds of positive pressure
ventilation with 100% FI02 the heart rate is
a. below 60
b. between 60-80 and not increasing
Technique:
a. 1 fingers breadth below nipple line, using 2 fingers
b. 1/2 to 3/4 compression depth
c. accompanied by ventilations, ratio is 3:1
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28. Chest Compressions
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

29. Medications
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30. • Naloxone Hydrochloride (Narcan) 0.4mg/ml:
If there is severe respiratory depression and a history
of maternal narcotic administration within
the past 4hours.
• Sodium Bicarbonate 0.5: helps correct metabolic
acidosis, indicated when there is a prolonged arrest
that does no respond to other therapy.
Because it is a hyperosmotic solution, give slowly
in order to minimize the risk of intra ventricular
haemorrhage.
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Continue…

31. WHO Guidelines
Resuscitation practises not effective or even
harmful
 routine aspiration of babies mouth and nose
 routine aspiration of stomach
 stimulation by slapping or flicking the soles of its
feet
 postural drainage or slapping the back
 squeezing the chest to remove secretions
 routine giving sodium bicarbonate to newborns
who are not breathing
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32. WHO Guidelines
Care after successful resuscitation
 do not separate mother and newborn- skin-
to skin
 examine the newborn (body temp, count
breaths, observe indrawing and grunting,
malformations, etc)
 record the resuscitation and the problems.
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33. APGAR SCORE
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SIGN 0 1 2
Heart rate ABSENT <100 bpm >100bpm
Respiratory effort ABSENT Slow irregular Good crying
Muscle Tone LIMP Some flexion
extremities
Active motion
Reflex Irritability NO RESPONSE grimace Cough or sneeze
Color BLUE,PALE Pink body blue
extremities
All pink

34. APGAR SCORE
 7-10 points - The newborn should be active and
vigorous. Provide routine care.
 4-6 points - The newborn is moderately
depressed. Provide stimulation and oxygen.
 0-3 points - The newborn is severely depressed
and requires extensive resuscitation.
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38. Q. Below what heart rate are chest compressions
appropriate?
Q. What are the four questions to ask about the
newborn in your first assessment?
A. If the heart rate is below 60
bpm, administer chest
compressions.
A. 1. Term gestation?
2. Clear amniotic fluid?
3. Breathing or crying?
4. Good muscle tone?