Neonatal Cardiac Arrest
When in doubt, fix the breathing. Poor tone? Fix the breathing. Initial HR below 100? Try to fix the breathing. Poor color? You get it. Don’t be afraid to escalate from blow by, to PEEP, to BVM. If the baby has little to no respiratory effort, a couple initial breaths via BVM can quickly improve the situation - Aaron Wibberley MD
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image by: Lee Health Foundation
HWN Suggests
Resuscitating the Neonate
If the baby has continued bradycardia <60 with adequate compressions and ventilation, the next step in resuscitation is pharmacotherapy. The only medication to be used during a neonatal resuscitation is epinephrine. The standard dosing of 1:10,000 epinephrine is 0.1-0.3 mL/kg, which amounts to 0.01-0.03 mg/kg. This may be given every 3-5 minutes as in PALS and ACLS.
Epinephrine is preferentially given IV; however, access can be difficult to obtain. Venous access may be quickly achieved by placing an emergent umbilical venous line. Remember that the umbilical cord should have two small arteries and one floppy vein. Attempt to sterilize the umbilical stump and place an umbilical tie…
Resources
Preterm Neonatal Resuscitation
Usually, deliveries in the emergency department cause a dichotomy of emotions – initial anxiety, then relief and happiness. Most of our deliveries tend to be quick, precipitous, with hopefully just enough warning for us to grab gloves and remember where the baby warmer is. Unfortunately, when babies decide to struggle with their first few minutes of life, this becomes a lot more stressful for everyone.
Epinephrine Use during Newborn Resuscitation
Epinephrine use in the delivery room for resuscitation of the newborn is associated with significant morbidity and mortality. Evidence for optimal dose, timing, and route of administration of epinephrine during neonatal resuscitation comes largely from extrapolated adult or animal literature.
Neonatal Resuscitation – Airway, Temperature Control, Central Access, Hemodynamics, Glucose Control and Tranport
ABC rather than CAB as recruitment of the lungs using positive pressure support, oxygenation and ventilation takes precedence over chest compressions.
Newborn resuscitation and support of transition of infants at birth Guidelines
If the heart rate remains very slow (< 60 min-1) or absent after 30 seconds of good quality ventilation, start chest compressions.
Paediatric and neonatal cardiac arrest
You need not have a pulseless infant to start chest compressions; if they are bradycardic to below 60, CPR should commence.
Resuscitating the Neonate
Up to 10% of all newborns will require some assistance to begin regular breathing, and just under 1% of newborns will require extensive resuscitative efforts.
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