Newborn Resuscitation: A way to protect newborn from asphyxia Neonatorum

Newborn Resuscitation: A way to protect newborn from asphyxia Neonatorum

 newborn resuscitation for those babies who fail to start breating on their own

Failure to establish spontaneous respiration immediately after complete delivery of the baby is called asphyxia neonatorum.

Normal Respiration:

  • Normal newborn takes first respiration: within 6 seconds, majority within first 20 seconds,
  • Rhythmic respiration: by 30 seconds, and majority by 90 seconds after birth
  • Normal Rate is 40-60/ min

Prognosis / Consequence asphyxia neonatorum:

Causes of asphyxia neonatorum:

  • Failure of respiratory center
    • prolonged hypoxia, birth trauma, maternal sedatives within 4 hours before delivery and preterm
  • Failure of pulmonary expansion (atelectasis)
    • low alveolar surfactant and poor respiratory movements of preterm baby
    • Fetal hypoxia causes lung edema
  • Obstructed air passageCirculatory collapse in neonatal shock
    • Inhaled mcous or meconium and choanal atresia
    • blood loss or cardiac abnormality

Signs and syndromes of asphyxia neonatorum:

  • Baby does not cry or cries very weakly
  • Baby does not breathe or breathes with difficulty, moaning or grunting
  • Does not move, extremities limp
  • Skin color is blue or pale
  • Heart rate is slow or absent

APGAR score:

Signs Score 0 Score 1 Score 2
Appearance Blue or pale Body pink, limbs blue Pink all over
Pulse (heart rate) Nil <100/min >100/min
Grimace Nil Feeble cry Cough or sneezing
Activity and tone Limp Flexion of limbs Active movements
Respiration Nil Slow, irregular Good, crying

Normal = 8-10. Mild asphyxia = 6-8. Moderate asphyxia = 4-6. Severe asphyxia = 0-3

Immediate Care of the Newborn at Birth (for both normal or abnormal newborn)

  • Step-1: Dry and stimuate
  • Step-2: Assess breathing and color
  • Step-3: Decide if resuscitation is needed
  • Step-4: Keep warm
  • Step-5: Tie and cut the cord
  • Step-6: Start breastfeeding

ABCDS of resuscitation: if needed
AIRWAY – make sure the airway is open

Position the baby

Suction the mouth and nose ,and if there is meconium, the pharynx (back of throat) also include in suction.

BREATHING- make sure the baby is breathing

Stimulate to initiate breathing

Use mouth to mouth or ambu bag breathing as necessary

Give oxygen, if available

CARDIAC FUNCTION- make sure the heart is beating

Stimulate the baby.

Do chest compressions when necessary.

Dry the mouth

Warm the baby with a blanket, a light, or the mother’s skin.


Make sure the baby is warm and dry.

MANAGEMENT: If resuscitation is needed.
A. Immediate management:

Steps of resuscitation:

  • Dry & Wrap
  • See Respiration/colour
  • Decide for resuscitation
  • Position, mouth to mouth respiration, ambu bag
  • Cardiac massage
  • Intubation
  • Drug

Subsequent management:

  • Fluid and nutrition should be maintained by IV 10% dextrose, NG tube feeding or oral feeding.
  • To control seizure: Inj. Phenobarbitone 20mg/kg IV followed by maintenance dose of 5-6mg/kg per day.
  • To control oedema: Fluid restriction 20-25% Mannitol may be used
  • IV antibiotic.

Resuscitation Procedure
A. Environment

  • Maintenance of temperature
  • radiant heater
  • warm cloths

B. Positioning

  • 1 inch roll of cloth below shoulder
newborn resuscitation correct position of baby
newborn resuscitation  airways should be straight


C) Suctioning
Should not be done always . When?

  • Meconium in amniotic fluid
  • Asphyxiated baby, first mouth then nose

D) Tactile Stimulation

  • Drying
  • Flicking of soles
  • Rubbing the back

E) Assessment

  • Color
  • Respiratory effort.
  • Heart rate
  • Movements or Muscular activities

F) Ventilation


  • Apnea
  • Heart rate < 100 beats
  • Persistent central cyanosis


  • Mouth to mouth
  • Mouth to mask
  • Umbu Bag
  • Endotracheal intubation
newborn resuscitation mouth to mought ventilation
newborn resuscitation using ventilation with bag and mask
Keep in mind:

  • Rate of 40-60 breaths/min
  • Tight face mask should be present
  • Initial long inflation pressure-5 in number
  • Equal bilateral breath sound should be found
  • If good ventilation – count the Heart rate
  • If>100 and increase in respiration –stop ventilation

G) Chest compressions


  • If heart rate is <60 beats/min or 60-80 beats/min and not rapidly increasing despite adequate ventilation with 100% O2 for 30 seconds.
  • Discontinuation: Heart rate > 80 b/min
newborn resuscitation  cardiac massage
H) Medications: when?

  • Heart rate < 80 b/min despite adequate ventilation with O2 and chest compression for 30 sec.
  • Route:
    • Umbilical vein
    • Endotracheal tube

What are the drugs used?

  • Adrenaline:
    • Dose: 1-3ml/kg of 1:10,000
  • Volume Expanders:
    • Dose:10ml/kg 5% albumin-Saline or Ringers lactate
  • Sodium Bicarbonate:
    • Prolonged arrest/or
    • profound metabolic acidosis-
    • Dose: 2meq/kg of 4.2%
  • Naloxone:
    • Dose: 0.1mg/kg of 1mg/ml


newborn resuscitation  steps to be used

Fig:Inverted pyramid showing relative frequencies of Neonatal resuscitative efforts

If there is no gasping or breathing at all after 20 minutes of ventilation: Stop ventilation

Time is life!
Preparation, skill and speed is essential!



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