What is neonatal resuscitation?
Neonatal resuscitation is a series of emergency procedures performed by a doctor to support newborn babies who are not breathing, are gasping or have a weak heartbeat at birth. These skills allow a doctor to save the lives of newborn babies.
The chances of a baby needing resuscitation are high in case of
Globally, about one-quarter of all newborn deaths are caused by lack of oxygen (asphyxia) at birth, which can be prevented by effective and rapid resuscitation.
What are the necessities for neonatal resuscitation?
As the need for resuscitation is often unexpected, before every delivery a nurse will have on hand
- A warm labor room with good light sources to assess the baby
- An Ambu bag with a baby-sized mask
- Clean ties
- Clean towels
What are the steps in neonatal resuscitation?
The first 60 seconds after delivery are the most critical. The doctor will quickly assess and start resuscitation for the baby with
- Abnormal breathing or poor cry
- Floppy baby
- Blue or pale lips and tongue
- Low heart rate ( less than 100 beats/minute)
The doctor will follow the steps below and they will have about 30 seconds to achieve a response from one step before deciding on another intervention.
- Keeping the baby warm
- Immediately after birth, the baby will be wrapped in a dry, warm towel and rubbed gently, which may stimulate some babies to breathe.
- The baby’s back and soles of feet may be rubbed gently for five seconds to stimulate breathing.
- The baby is dried with warmed towels or blankets to avoid lowering of body heat, which may cause complications including death, especially in small preterm babies.
- Clearing the airway
- The doctor will clear the airway by sucking mouth secretions with a bulb syringe quickly within five seconds.
- The doctor will remove thick meconium (if present) using a wide port tube.
- Clamping and cutting the cord: If the baby is breathing adequately, then the doctor will
- Keep the baby at the same height as the placenta or below the placenta until the cord is clamped to enhance blood transfusion.
- Clamp the cord approximately one to three minutes after birth to minimize anemia (low red blood cells in the blood).
- Return the baby to the mother for skin-to-skin contact to keep the baby warm.
- Opening the airway for breathing: If the baby is still not breathing, to open the airways
- They will be kept on a flat surface on their back.
- Their head will be kept in a neutral position (parallel to the surface).
- A two to three centimeter thick folded towel will be placed beneath their shoulders.
- Keeping the baby breathing: If the baby still does not breathe with a low heart rate (less than 100 beats/minute), then the doctor will
- Place a mask over the baby’s mouth and nose, connecting it with an Ambu bag.
- Provide five inflation breaths by slowly squeezing the bag.
- Provide a two- to three-second long breath by counting out loud to allow accurate rhythm.
- Inspect the baby’s chest movement.
- Reassess the inflation and listen to the heart rate (normal is greater than 100 beats/minute) and check whether the baby is breathing.
- Repeat the maneuver if the baby is still not responding or use jaw thrust alone by himself or with the help of another attendant to open the airway.
- Return the baby to the mother for breastfeeding and skin-to-skin contact if the baby starts breathing.
- Monitor the baby further for six hours.
Infants who continuously have a heart rate higher than 100 beats/minute and adequate respiratory effort but who remain blue around the lips and tips should receive blow-by oxygen aided by oxygen tubing or a mask under expert guidance.
- Chest compression: Rarely, some babies may need chest compressions if the heart rate is absent or low (less than 60 beats/minute) and not responding to being resuscitated with an Ambu bag. Then the doctor will
- Hold the baby’s chest with two hands while placing the thumbs below the nipples.
- Press the baby’s chest with their thumbs quickly. Another method in smaller babies is using the index and middle fingers to gentle press over the breastbone.
- Make sure there is time for the chest to recoil.
- Provide three chest compressions to one breath with the help of an attendant.
- Continue chest compression until the baby’s heart rate gets to normal.
- Check for responses by listening to the baby's heart rate every 30 seconds to one minute and see chest movements with each breath, after each intervention.
When should a doctor stop resuscitation?
In the majority of cases, the above steps are enough to save a baby. Even after this if there is no improvement, infants may require tracheal intubation if endotracheal (ET) administration of medications is desired, congenital diaphragmatic hernia is suspected or there is a prolonged need for assisted ventilation. Such measures are only done in a neonatal intensive care unit (NICU) supervised by an experienced doctor. These decisions should be made by the parents and clinician. Each country's guidelines vary as to when a doctor should stop resuscitation attempts (from 10 to 20 minutes after birth).
Health Solutions From Our Sponsors
Medecins Sans Frontieres
NICE UK Guidelines
Top What Are the Steps in Neonatal Resuscitation Related Articles
Childbirth Delivery Methods and TypesThere are various childbirth delivery methods and types such as the Lamaze method, the Bradley method, water birth, and assisted births. Options for where a woman can deliver her baby include home birth, a birthing center, and a hospital. The method and type of labor and delivery options should be discussed with a woman's doctor.
Babies QuizTake the Babies Quiz to learn what milestones and developments you can expect from your baby’s first year.
Baby Skin Care: Tips to Keep Newborn’s Skin HealthyBaby skin care products can help with peeling, rashes, baby acne, and dryness that can develop on a newborn baby's skin. Develop a baby skin care routine to pamper your baby’s skin.
Newborn Skin CareWhat does normal baby skin look like? These photos will guide you in proper baby skin care. Learn how to care for your baby's skin with these diapering and bathing tips.
How Long Can a Newborn Go Without Peeing?A newborn baby usually passes urine for the first time within 12 to 24 hours after birth. Not peeing in the first 24 hours points to some urinary tract problem. As the mother and her baby need to stay in the hospital for 24 to 48 hours after a normal delivery, it becomes easy for the doctors to diagnose the condition early.
How Safe Is Breech Delivery?The breech pregnancies are not dangerous until it’s time for the baby to be born. In the breech presentation, the baby’s feet or bottom is located at the opening of the uterus instead of the baby’s head. The head is the largest part of the baby that must fit through the birth canal.
Is Breech Delivery Safe?The breech pregnancies are not dangerous until it’s time for the baby to be born. In the breech presentation, the baby’s feet or bottom is located at the opening of the uterus instead of the baby’s head. The head is the largest part of the baby that must fit through the birth canal.
Jaundice (Newborn, Kernicterus)Jaundice in infants occur when the baby's liver may not be developed enough to efficiently rid the body of bilirubin. Symptoms of jaundice include yellowish colored eyes, and yellowing of the skin. Some babies are more at risk to develop jaundice. Kernicterus is a type of brain damage that occurs when a baby has jaundice and is not treated. Treatment of infant jaundice is generally with phototherapy so that kernicterus should not develop.
Labor and DeliveryEarly and later symptoms and signs of labor and delivery are unique to each woman. Early signs of labor are "lightning" and passing the mucus plug. Later symptoms and signs that labor that labor is are the woman's water breaking, and when contractions begin. There are three stages of labor, stage 1 is the longest and occurs when the cervix begins to thin and dilate. During stage 2 of labor the baby passes through the birth canal and remains there until delivery, and stage 3, is when the baby is delivered.
Newborn Infant Hearing ScreeningA newborn infant hearing screening is performed before a child is discharged from the hospital. If an infant doesn't pass the test, a rescreen is performed. Detecting hearing loss at an early age increases a child's chance of having a healthy and more productive life. There are two methods of testing hearing in infants: auditory brainstem response (ABR) and otoacoustic emission (OAE). Both tests are accurate, automated, and don't require a visible response from the infant.
Newborn Jaundice (Neonatal Jaundice)
Jaundice in newborns and babies (neonatal jaundice) usually occurs because of a normal increase in red blood cell breakdown and the fact that their immature livers are not efficient at removing bilirubin from the bloodstream.
Symptoms of jaundice are fever, poor feeding, and looking ill. Newborn jaundice is very common and is caused because the newborns liver isn’t mature enough to remove bilirubin from the blood.
Treatment of jaundice in newborns include phototherapy, tanning booths, and other treatments.
Salmon Patch on Newborn PictureSalmon patch on the glabella of a newborn. See a picture of Salmon Patch on Newborn and learn more about the health topic.
Urine Blockage in NewbornsThere are many syndromes and defects that may cause urine blockage in newborns. Defects in the urinary tract that may cause urine blockage include vesicoureteral reflux, ureteropelvic junction obstruction, bladder outlet obstruction, posterior urethral valves, nerve disease, and ureterocele. Syndromes that may cause urinary blockage include congenital heart defects, esophageal atresia, and prune belly syndrome. Treatment for urine blockage in newborns depends on the cause of the blockage.
Why Is Forceps Delivery Done?Forceps delivery is a type of assisted delivery in which tong-shaped instruments are used to ease the baby out of the birth canal. These instruments are used to cradle the baby’s head in the vagina and turn the baby into a better position if needed so that they can be guided out.