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  • Most newly born infants will respond to adequate stimulation and warming. Very few will require advanced life support.
  • Chest compressions are only initiated if there is no pulse or if the heart rate remains <60 beats/min after adequate assisted ventilation for 30 seconds.
  • Only isotonic crystalloid or packed red blood cells should be used for initial volume resuscitation. Albumin-containing solutions are not recommended.
  • The dose of epinephrine for the newly born infant should be 0.1 to 0.3 mL/kg of 1:10 000 solution. Higher doses of epinephrine are not recommended.
  • When meconium-stained amniotic fluid is present, mouth and nasal suctioning after delivery of the head is no longer recommended. Intratracheal suctioning should only be performed if after delivery the infant has absent or depressed respirations, decreased muscle tone, or a heart rate <100 beats/min.
  • Laryngeal mask airways may be considered for assisted ventilation in the hands of experienced providers.
  • The best site to palpate for pulses in the newly born infant is the umbilicus.
  • The umbilical vein is the best site for intravenous access.
  • The ratio of chest compressions to ventilations in the newly born infant should be 3:1, with 90 compressions and 30 ventilations per minute.
  • The recommended technique for chest compression in the newly born infant is the two-thumb-encircling hands technique.
  • Epinephrine is indicated for asystole or a heart rate <60 beats/min after 30 seconds of adequate ventilation and chest compressions.


Of the nearly 4 million infants that are born in the United States each year, more than 90% will successfully transition from intrauterine life with little or no intervention. Roughly 10% will require some assistance and 1% will require more extensive resuscitation.1 This is greatly influenced by factors such as prematurity, since premature infants are at a much higher risk for requiring resuscitation. 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 therefore needs to understand neonatal resuscitation. As in any critical situation in medicine, preparation and anticipation play a key role in neonatal resuscitation. This includes equipment (Table 27–1) 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.2 For deliveries in the emergency department, it is preferable that at least three providers who are experienced in neonatal resuscitation should be present.2

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Table 27-1. Supplies for Neonatal Resuscitation3

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