Resuscitation Protocol
See resuscitation manual for more detail. See the resuscitation algorithm ( appendix ) and formulary for doses of resuscitation drugs. Virtually all babies should be offered resuscitation at birth; exceptions would include BW < 500g, previously diagnosed severe congenital abnormalities, macerated stillborns and neonates in which no fetal heart rate was detectable in the last hour p
See resuscitation manual for more detail. See the resuscitation algorithm (appendix) and formulary for doses of resuscitation drugs.
Virtually all babies should be offered resuscitation at birth; exceptions would include BW < 500g, previously diagnosed severe congenital abnormalities, macerated stillborns and neonates in which no fetal heart rate was detectable in the last hour prior to delivery. If you have any doubts rather initiate resuscitation and continue until advised to stop by a senior member of paediatric staff.
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Anticipate
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If called to delivery, check all resuscitation equipment before delivery
If called for preterm twins: need staff and equipment for 2 resuscitations
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At delivery
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Time birth
Dry and warm baby
If baby not crying then continue with resuscitation
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Airway
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Position head = “Sniffing position” (don’t hyper-extend)
Suction = If copius secretions. Not necessary in the vast majority of deliveries
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Breathing
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Look, listen & feel. Initial gasps usually quite obvious
If no breaths or irregular gasps do bag/valve/mask ventilation for 15-30 seconds with room air
Rate:
60 breaths per minute (bag, 2, 3, bag, 2, 3...) i.e. not too fast
Method:
Chest moves “normal amount”
Mask covers mouth and nose, but not eyes
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Circulation
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Check heart rate (by heart sounds or umbilical/brachial pulse) If HR = 60-100, continue ventilation. If HR<60/min, commence chest compressions Rate: 90 compressions and 30 breaths per minute (1, 2, 3, bag...) Method: Use 2 thumbs encircling technique Compress vertically over sternum One fingerbreadth below inter-nipple line (above xiphisternum) |
| Drugs | Not commonly required in neonatal resuscitation Adrenaline after 1 minute of full CPR if HR still<60 Adrenaline every 3 minutes if HR remains <60 0.9% saline if blood loss suspected |
| Evaluation | Evaluate ABC regularly, and evaluate reasons why not improving Simple reasons for failure of resuscitation are common e.g. chest not moving because airway not open (may also be faulty Ambubag, poor seal, pneumothorax etc.) |
| ETT | Endotracheal intubation may help with ventilation. It may be done early if you are confident, but bag/valve/mask is often sufficient if you are struggling and have called for assistance. Oral intubation is appropriate for resuscitation. ETT size: Approx 1kg = 2.5, for 1-2 kg = 3, for >2kg = 3.5 ETT depth: Use vocal cord marker, or at lips = 6+wt |
| End | Stop Chest compressions if HR >60 Stop ventilation if breathing regularly Wean O2 by saturation in labour ward nursery Stop resuscitation if no heart rate after 10 minutes, following consultation with more senior member of paediatric staff |
Rahima Moosa Mother and Child Hospital - Neonatal Care Handbook 2023; Resuscitation protocols
Last checked for updates: January 2024