Neonatal Resuscitation

Neonatal resuscitation is the structured support of airway, breathing and circulation immediately after birth. Most newborns transition without intervention. The critical minority usually require effective ventilation rather than medication or chest compressions.

The single most important determinant of successful neonatal resuscitation is effective lung inflation.

Immediately assess:

• Term or preterm status
• Tone
• Breathing or crying
• Heart rate

Resuscitation is required when the newborn is apnoeic, gasping, has ineffective respiration, or persistent bradycardia.

Heart rate guides escalation:

• 100/min or greater: usually adequate circulation
• 60 to 99/min: ventilation is the priority
• Below 60/min despite effective ventilation: commence chest compressions

No diagnostic testing should delay resuscitation.

Assess heart rate using auscultation, ECG where immediately available, or pulse oximetry.

Pulse oximetry should be preductal, usually on the right hand or wrist, when oxygen titration is required.

• Provide warmth, position the airway, dry where appropriate and stimulate briefly.

• If apnoeic, gasping or heart rate below 100/min, begin positive pressure ventilation within the first minute of life.

• Ventilate at approximately 40 to 60 breaths/min, ensuring visible chest movement.

• If the chest does not move, correct mask seal, airway position and obstruction before escalating.

• If heart rate remains below 60/min after at least 30 seconds of effective ventilation, start chest compressions using a 3:1 compression to ventilation ratio, approximately 90 compressions and 30 breaths each minute.

• If heart rate remains below 60/min despite effective ventilation and coordinated compressions, give adrenaline 10 to 30 micrograms/kg IV, equivalent to 0.1 to 0.3 mL/kg of 1:10,000 solution, preferably through umbilical venous access.

• Consider 0.9% sodium chloride 10 mL/kg IV over 5 to 10 minutes when acute blood loss or hypovolaemia is strongly suspected.

Routine tracheal suctioning for meconium is not required. Ventilation takes priority.