Neonatal Resuscitation in the Delivery Room

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Neonatal Resuscitation in the Delivery Room

• In the delivery room, the initial assessment of a newborn is crucial to determine the need for resuscitation. This lecture will provide a step-by-step guide to neonatal resuscitation, focusing on essential criteria and key steps.

Term, Tone, and Tantrum Assessment:

• Upon delivery, evaluate the neonate using the following criteria:
• 1. Term: Determine if the neonate is full or late pre-term gestation (above 34 weeks).
• 2. Tone: Assess for flexed extremities rather than floppiness.
• 3. Tantrum: Check for a good cry and respiratory effort.

Delayed Cord Clamping:

• Neonates which do not require resuscitation can be placed skin-to-skin with the mother for breastfeeding. 
• Delayed cord clamping for 60 seconds is recommended for improved neurodevelopmental outcomes and iron stores in the first year of life.

Prompt Resuscitation for Neonates:

• For neonates not meeting the "Term, Tone, and Tantrum" criteria, prompt resuscitation is necessary, which include the following steps.
• 1. Warmth: Utilize a radiant warmer to maintain temperatures between 36.5°C and 37.5°C.
• 2. Dryness: Ensure the neonate is kept dry to prevent heat loss.
• 3. Stimulation: Provide tactile stimulation to elicit a cry and promote respiratory effort.

Avoid Routine Bulb Suctioning: 

• Avoid routine bulb suctioning unless there is significant obstructing mucus, as it can lead to increased vagal tone and bradycardia. If suctioning is required, start with the mouth before the nose.

Positive Pressure Ventilation:

• Initiate positive pressure ventilation with bag-valve-mask or intubation if the heart rate drops below 100 beats per minute. 
• Prioritize adequate ventilation, as it is paramount in neonatal resuscitation.

Chest Compressions and Epinephrine:

• Initiate chest compressions at a rate of 120 beats per minute if heart rate persistently less than 60 beats per minute despite positive pressure ventilation.
• If chest compressions are not effective, give intravenous epinephrine 0.01 to 0.03 milligrams per kilogram every 3 to 5 minutes.

Consider Blood Loss and Pneumothorax:

• Consider blood loss and pneumothorax if the neonate responses poorly to initial resuscitation.

• Neonates in shock from blood loss or pneumothorax may respond poorly to the initial resuscitative efforts of ventilation, chest compressions, and epinephrine.