1. RESUSCITATION OF
THE
NEWBORN BABY

2. Why we need to resuscitate:
pH 7.30
pH 7.00
pH 6.80

3. How often do we use our
resuscitation skills?

4. PREPARING FOR BIRTH
Wash your hands
 Draught free, warm room - temperature >250C
 Clean, dry and warm delivery surface
 Radiant heater
 Two clean, warm towels/clothes
 A folded piece of cloth
 Self inflating bag - newborn size
 Infant masks in two sizes - normal and small newborn
 Suction device
 Oxygen (if available)
 Clock
Check if all equipments are in working order

5. ASSESSMENT AT BIRTH
 Deliver the baby on to mother’s abdomen
 Note and call out time of birth
 Thoroughly dry the baby
 Use a warm towel
 Discard wet towel after drying
 Wrap the baby in another warm cloth
Keep the baby warm
Assess breathing while drying
5

6. CARE OF THE BABY AT
BIRTH
Assess breathing:
Assessment
Baby is crying
Decision
Baby is not crying, but breathing at
30 to 60 times per minute
Baby is gasping
No need for resuscitation or
suctioning;
Start skin-to-skin contact and
breastfeeding
No need for resuscitation or
suctioning
Start resuscitation immediately
Baby is not breathing
Start resuscitation immediately
H- 6

7. Newborn Resuscitation Algorithm.
Kattwinkel J et al. Pediatrics 2010;126:e1400-e1413
©2010 by American Academy of Pediatrics

8. Dry the baby
immediately after birth
Immediate
skin-to-skin
Contact &
Breastfeeding
(routine care)
8

9. Steps of resuscitation
If the baby is not breathing or gasping
◦ Call for help!
◦ Cut cord quickly, transfer to a firm, warm surface
[under a radiant heater]
◦ Inform the mother that baby has difficulty breathing
and you will help the baby to breathe
◦ Start newborn resuscitation
9

10. Suction
Equipment
Warmer &
Blankets
Bag, Mask,
& Oxygen
Laryngoscope
and ETT Tube

11. Steps of resuscitation
Position
11

12. Steps of resuscitation
Position, clear airways (if needed)
Suction: Do not exceed duration of 20 sec
12

13. Steps of resuscitation
Dry, stimulate, reposition
13

14. Steps of resuscitation
Dry, stimulate, reposition
14

15. Steps of resuscitation
Ventilate (if still not breathing)
Selecting Bag & Mask equipment
• Size of bag: 240-750 ml
• Oxygen capability: Oxygen
source, reservoir
• Safety feature: Pop off valve,
pressure gauge (optional)
15

16. Steps of resuscitation
Ventilate
Use the CORRECT size face mask
that covers:
 The nose
 The mouth
 The tip of the chin
but not the eyes
16

17. Steps of resuscitation
Fitting a face mask:
• A face mask that is too LARGE
– Covers the eyes
– Extends over the tip of the chin
• A face mask that is too SMALL
– Does not cover the nose
– Does not cover the mouth effectively
17

18. Steps of resuscitation
Ventilate
 Squeeze bag with 2 fingers or whole hand,
2-3 times
 Observe for rise of chest
 IF CHEST IS NOT RISING:
◦ Check seal
◦ Reposition the head
◦ Squeeze harder
 Once good seal and chest rising, ventilate
at 40 squeezes per minute
 Observe chest rise
 Check heart rate after 30 seconds
18

19. Steps of resuscitation
When to stop ventilating?
If baby is crying;
If breathing >30/min, and
NO chest in-drawing:
◦ If the skin between the ribs
is ‘sucked’ inwards and the
ribs are prominent, the
baby has chest ‘in-drawing’
19

20. Steps of resuscitation
After stopping ventilation
 Put the baby in skin-to-skin contact on mother’s
chest
 Monitor every 15 minutes for breathing and
warmth
 Tell the mother the baby will probably be well
 Encourage the mother to start breastfeeding as
soon as possible
NEVER leave the baby alone
20

21. Steps of resuscitation
When to continue ventilating?
If the baby
– is breathing at a rate of <30/min,
– is gasping
– has severe chest in-drawing
• Arrange for immediate referral
21

23. MECONIUM STAINED AMNIOTIC
FLUID
No need for intrapartum suction
Birth: assess
HR, breathing and tone
Vigorous: HR>100
good breathing
Nonvigorous: any
parameter abnormal
Good tone
Initial steps
Tracheal suction
23

24. Steps of resuscitation
Special considerations for preterm
• Be gentle
• Use small size resuscitation bag and give small
tidal volumes to move chest
• Avoid 100% oxygen , use blenders and oxygen
saturation monitors
• Avoid rapid fluid bolus
• May need intubation, chest compression,
medications
24

25. Post resuscitation
management
Principles
1. Keeping normal temperature
2. Maintaining oxygenation
3. Maintaining physiological milieu- fluids ,
glucose
4. Maintaining perfusion
5. Treating seizures
6. Monitoring organ function
25

26. Care after resuscitation
•
•
•
•
•
Place baby in skin-to-skin contact with mother
Keep the baby warm
Monitor every 15 minutes
Start breastfeeding as soon as possible
Discuss what has happened with the parents be positive!
• Do not separate the mother and baby unless
the baby has difficult breathing
26