Newborn resus

NSW protocols

How to perform rapid assessment on a newborn

Newborn is POSITIVE (ie begin resus) if any of the following are present:

• HR <100 (most sensitive)

• Hypotonia

• Apnoeic or gasping breaths

What is the cause of most newborns requiring resus?

Apnoea/bradycardia due to ineffective ventilation

How do you measure the HR of a newborn?

Auscultation or umbilical cord

Where should you place the sats probe on a newborn?

R) hand/wrist (pre-ductal)

What is the first step once determining newborn is positive to rapid assessment?

• 30 seconds of drying with towel, tactile stimulation

• For newborns <32wks, place body into polyurethane bag, head exposed. Dry head, cover, stimulate over bag

• Clamp and cut cord

• Reassess after 30 seconds

If there is no response to stimulation, what is the next step? How do you position the newborn

• Begin newborn resus

• Supine, head NEUTRAL (different airway anatomy),

• consider padding under shoulders

• Ensure head covered to reduce heat loss

When and how do you use suction on a newborn?

• Only if obvious obstruction or baby not vigorous after exposure to meconium stained liquid

• Use with caution due to increased risks of adverse effects to airway and hypoxia

• use for 5 seconds at a time

• Avoid deep insertion

First step of newborn resus after 30 seconds tactile stimulation if still positive to rapid assessment or RR <40?

• IPPV on RA for 30sec

• Consider OPA

• Peep if advised by hospital

• Reassess after 30 sec

What is the next step if baby is still positive to rapid assessment/RR <40 after 30 sec IPPV on RA?

• Repeat IPPV on RA for 30 sec

• Prepare O2 and extrication

If after 1min of IPPV on RA, pt’s HR is 60-<100, how do you proceed?

• IPPV with O2 100%

• reassess every 30sec

• if HR reaches >100, begin post resus care

• If nil response, continue mx and load and go

If after 1 min of IPPV on RA, pt’s HR is <60, how do you proceed?

• Begin CPR at a ratio of 3:1, with O2

• Reassess every 30 seconds

• Load and go if nil response

Are defib pads indicated in newborn resus?

No.

What is the aim with the first ventilations of a newborn?

• to clear fluid in the lungs, establish lung aeration and enable gas exchange

• This should assist to initiate the newborns own respiratory effort

At what rate should you ventilate the newborn?

40/min

How many compressions and ventilations per minute are you aiming for?

• 120 compressions and 30 ventilations

• Allow ½ second pause after the 3rd compression for the ventilation

What newborns are high risk of requiring resus at birth?

• Premature babies

• Shoulder dystocia

• Breech

• Multiple birth

• Congenital abnormalities

What are the risks of not keeping a baby warm?

Hypothermia in the newborn increases O2 demand, risk for hypoglycaemia and acidosis

These lead to increased mortality

Post resus care key principles:

• skin to skin

• maintain warmth

• mx for hypoglycaemia if BSL <2.6

• APGAR at 5/60