ABC of Neonatal Resuscitation
Position and clear
Stimulate to breathe
Assess heart rate and
color
+
Drugs
If a baby does not begin breathing
immediately after being stimulated, he
or she is likely in secondary apnea and
will require positive pressure
ventilation. Continued stimulation will
not help.
Apgar score is not used
to determine the need
for resuscitation
Always remember
The most effective and
important action in neonatal
resuscitation is to ventilate the
baby’s lungs with oxygen.
Initial steps of Resuscitation
Provide warmth
Position, clear airway as necessary
Dry, stimulate and reposition
Ongoing evaluation
Provide warmth
Radiant warmer
Position by slightly extending the neck
Meconium suctioning after delivery of the
head
Clear the airway as necessary (if
meconium is present)
Clear the airway as
necessary
(if no meconium)
M before N
PROVIDING TACTILE STIMULATION
If necessary
Stimulating the soles, either by slapping
or flicking the feet, initiates respirations
in the mildly depressed infant.
Slapping the
sole of the feet
Flicking the heel
PROVIDING TACTILE STIMULATION
Quickly and firmly rubbing the infants
back is another safe method of attempting
to initiate respiration.
Rubbing the infant’s back
After clearing the airway as necessary, drying and
removing wet linen, repositioning, and stimulating,
evaluate respirations and heart rate (not color).
a. If HR is less than 100 bpm, or if newborn is
apneic or gasping, begin positive-pressure
ventilation.
b. If HR is more than 100 bpm and respirations are
labored, consider CPAP, especially for preterm
newborns.
What do you need to check before
assisting ventilation with a
resuscitation bag ?
Select appropriate-sized mask
Be sure there is a clear airway
Position the baby’s head
Position yourself at the bedside
Select appropriate-sized mask
Position the baby’s head
Correct-sized mask covers mouth, nose and
tip of chin, but not the eyes
Correct position for assisted ventilation
Correct
Wrong
Correct
Position yourself at
the bedside
Position the mask on the face
Pointed end over the nose
Encircle rim of mask with fingers
Ring finger bring the chin forward
How often should you squeeze the bag ?
Counting out loud to maintain a rate of 40 to 60 breaths per minute
If you still are unable to obtain
adequate chest expansion after
going through this sequence,
endotracheal intubation and bagand-tube ventilation will usually be
required
 When to begin chest compression ?
 How to administer chest compression ?
 How to coordinate chest compression
with PPV ?
 When to stop chest compression ?
Chest compression should be
started whenever the HR is
< 60 bpm despite effective PPV
(after taking the ventilation
corrective steps)
2 persons are required when chest compressions are given
Where should they stand ?
2 techniques
Thumb technique
Two-finger technique
Where should position your
thumbs or fingers ?
One cycle (2 seconds): 90 compressions plus 30 breaths
Indications
Infants may require tracheal intubation if:
• Direct tracheal suctioning is required
• PPV by bag and mask is not resulting in good chest rise or
needed beyond few minutes
• Chest compressions are necessary
• Epinephrine is required
• Other indications:
Extreme prematurity
Surfactant administration
Congenital diaphragmatic hernia is suspected
Endotracheal tube
Size and length of ETT according to weight
Weight
ETT size
ETT measurement at lip
( Tip -to- Lip )
<1000 g
2.5 ETT
7 cm at the lip
1000-2000 g
2.5-3 ETT
8 cm at the lip
2000-3000 g
3-3.5 ETT
9 cm at the lip
>3000 g
3.5-4 ETT
10 cm at the lip
Role of 6
Wt (kg) + 6 cm = tracheal tube insertion depth at lip in cm
Position for endotracheal intubation
Laryngoscope in Lt hand
Tilt the blade then lift
vertically to visualize the
glottis
Pass ETT to oropharynx
Keep ETT outside curve
of laryngoscope
Pass the blade
beneath epiglottis
Lift blade vertically to
visualize glottis
An assistant may
press larynx for
better visualization
Incorrect
Correct
Use small stethoscope and place it laterally and high on the chest wall
(in the axilla).
Medications
• Drugs are rarely needed in the immediate
resuscitation of infants.
• They should only be administered after
ventilation has been established.
• Umbilical vein is the route used for
emergency administration of drugs in the
delivery room because of rapid delivery to
the central circulation.