Neonates delivered with apnoea require resuscitation. Effective resuscitation can prevent most neonatal deaths at birth. The first 60 seconds are the most critical (golden minute) – positive pressure ventilation should be started during this period.
Definition of terms
| Term | Definition |
|---|---|
| Primary apnoea | Cessation of breathing and bradycardia due to a significant lack of oxygenation before or during delivery. This responds to simple stimulation, and the baby may resume breathing. |
| Secondary (terminal) apnoea | A more severe phase of apnoea after prolonged hypoxia. It is characterised by cessation of breathing and bradycardia (often < 60 bpm). This requires active resuscitation. |
- Summary of neonatal resuscitation
- Warm, dry, stimulate
- Ventilation is the most important step; most babies improve with positive pressure ventilation alone
- Chest rise = effective ventilation
- HR < 100 → ventilation
- HR < 60 → chest compressions
- HR persists < 60 → adrenaline
- Preparation
- Gather information
- Expecting twins
- Preterm or small
- Maternal infection
- Prolonged labour
- Bleeding
- Evidence of meconium
- Prepare the room
- Warm and free from draughts
- Switch on the radiant warmer
- Good light source
- Flat firm surface with warm, clean towels
- Equipment
- Self-inflating bag
- Masks
- Stethoscope
- Clock
- Clean ties and scissors to cut the cord
- Wash your hands and put on gloves
- Gather information
- Components of neonatal resuscitation
- Keeping the baby warm
- Remove wet towels
- Stimulate by rubbing the back
- Wrap in warm, dry cloth
- Initiate skin-to-skin contact with the mother if stable
- Assessing the baby:
- Assess the colour, tone, breathing, and heart rate (HR).
- A normal baby should have regular breathing, good colour, good tone and HR above 100 breaths per minute.
- A compromised baby will not breathe (or will be gasping), will be floppy, will have blue or pale lips and tongue, and bradycardia of < 100bpm.
- Keep the baby below the placenta and delay cord clamping (1-3 minutes) if the baby is well to allow placental transfusion and prevent newborn anaemia.
- Early cord clamping (< 1 minute) should be done for infants who are not breathing or have bradycardia < 100 bpm.
- Opening the airway and breathing:
- Open the airway by keeping it in a neutral position using head tilt (the neck should not be flexed or extended).
- A folded towel can be placed below the shoulders to achieve this position.
- Give 5 inflation breaths if the baby is not breathing or if there is bradycardia of < 100 – the lung is only inflated if the chest is moving.
- Count out loud to keep an accurate rhythm – 1 2 3, 2 2 3, 3 2 3, 4 2 3.
- Usually, all that is needed is to keep the head in a neutral position and give 5 inflation breaths.
- Once the baby starts breathing, return them to the mother to be kept skin-to-skin.
- Monitor respirations regularly and keep under observation for 6 hours.
- Chest compressions
- Give chest compressions if there is bradycardia of < 60 bpm after 30 seconds of effective ventilation
- Encircle the chest with both hands, with the fingers supporting the spine.
- 3 chest compressions to one breath
- Reassess after 60 seconds
- HR ≥ 60 bpm → stop compressins
- HR < 60 bpm → continue and give drugs
- Medications
- Adrenaline if HR < 60 bpm despite effective ventilation and chest compressions
- Volume expansion if blood loss or shock is suspected
- Keeping the baby warm