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High-Yield Facts

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  • The vast majority of newly born infants will respond to tactile stimulation and warming. Very few will require advanced life support.

  • Neonatal resuscitation is focused chiefly on respiratory support, not on cardiac support, unlike resuscitation for adults or older children.

  • Healthy term newborns may take 10 minutes or longer to reach normal extrauterine oxygen saturations.

  • The use of preductal pulse oximetry is recommended because skin color can be a poor indicator of oxygen saturation.

  • The use of oxygen/air blenders is recommended to decrease exposure to 100% oxygen which has been increasingly shown to have toxic effects.

  • When meconium-stained amniotic fluid is present, mouth and nasal suctioning after delivery of the head is not recommended. Intratracheal suctioning should only be performed after delivery if the infant has absent or depressed respirations, decreased muscle tone, or a heart rate less than 100 beats/min.

  • Laryngeal mask airways may be considered for assisted ventilation of term or near-term newborns in the hands of experienced providers.

  • Chest compressions are only initiated if there is no pulse or if the heart rate remains less than 60 beats/min after adequate positive-pressure ventilation (PPV) for 30 seconds.

  • The ratio of chest compressions to ventilations during resuscitation should be 3:1, with 90 compressions and 30 ventilations per minute.

  • The recommended technique for performing chest compressions is the two-thumb–encircling hand technique.

  • The best site to palpate for pulses in the newly born infant is the umbilical stump.

  • The umbilical vein is the best site for intravenous (IV) access.

  • Only isotonic crystalloid or packed red blood cells should be used for initial volume resuscitation.

  • Epinephrine is indicated for asystole or a heart rate less than 60 beats/min after 30 seconds of adequate ventilation and chest compressions.

  • The dose of epinephrine for the newly born infant is 0.1 to 0.3 mL/kg of 1:10,000 solution given intravenously. Higher doses are not recommended.

  • Therapeutic hypothermia instituted after resuscitation may improve neurologic outcomes for term infants with hypoxic-ischemic encephalopathy (HIE).

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Background

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Of the nearly 4 million infants that are born in the United States each year, more than 90% successfully transition from intrauterine life with little or no intervention. Roughly 10% require some assistance and 1% require more extensive resuscitation.1 Because of the large number of births, it is inevitable that the emergency medicine practitioner will be faced with a newly born infant in their emergency department and the need for neonatal resuscitation. As in any critical situation, in medicine, preparation and anticipation play a key role in neonatal resuscitation. This includes equipment (Table 21-1) and personnel to be ready as soon as a newly born infant presents to the emergency department. Current American Heart Association (AHA) guidelines recommend that at least one skilled provider should attend every birth in the delivery room and three skilled providers should be present for deliveries in the emergency department.2

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Table Graphic Jump Location
TABLE 21-1Neonatal ...

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