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Neonatal Resuscitation – Airway, Temperature Control, Central Access, Hemodynamics, Glucose Control and Tranport

There is something indescribable that happens when the overhead speaker crackles overhead with “Code Pink”. The stakes are high, and every person in the building collectively holds their breath. It’s in the air. All the more reason to know neonatal resuscitation better than the back of your hand. This is not an easy task.

We’re talking about – hopefully – once-in-a-career events that require expertise, precision, and outstanding team dynamics. Resuscitation of the sick newborn is a HALO situation – High Acuity Low Opportunity for most of us.

But there are few things in medicine more worthwhile knowing. Now, just to get things in perspective, thankfully about 90% of births…

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Featured

  Twenty Tips to take your Neonatal Resuscitation to the Next Level - Part 1

This post shares a few of my own tips and idiosyncrasies in preparing for and undertaking neonatal resus, particularly in the regional setting where a tertiary NICU isn’t just a buzzer and short walk away.

 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.

 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.

 Twenty tips to take your Neonatal Resus to the next level - Part 2

Neonatal resus should be both easy and scary, every time. If you’re not even a little, tiny bit scared, you’re quite possibly “doing it wrong”, and almost always, sticking to the algorithm ensures that you do the right thing for the patient.

Articles of Interest

Management of an Unexpected Delivery in the Emergency Department

For those who do not routinely care for newborn infants in the immediate postdelivery period, facing a sudden unexpected need to fill the role can be anxiety provoking, particularly if the infant requires care beyond the routine.

Neonatal resuscitation in global health settings: an examination of the past to prepare for the future

An estimated two-thirds of the world’s 2.7 million newborn deaths may be prevented with basic quality care at birth and during the postnatal period. On a global scale, many successes have been achieved in the implementation of neonatal resuscitation: decreased neonatal mortality, decreased still birth rates, and increased use of alternative cadres of providers.

Neonatal Resuscitation in the Emergency Department

Only 10% of full-term infants will require assistance with breathing after birth, and 0.1% will require extensive resuscitation.

Newborn resuscitation and support of transition of infants at birth

In management of the umbilical cord, clamping after at least 60 seconds is recommended, but if this is not possible cord milking is an option in babies > 28 weeks gestation.

Newborn Resuscitation: The Golden Minute

The most common cause of bradycardia in the newborn is hypoxia, which is easily reversed with bag-valve mask ventilation.

Simulation in Neonatal Resuscitation

Neonatal resuscitation is a high risk, low occurrence (HALO) situation. Even in tertiary centers with highly experienced teams, resuscitations guidelines are not strictly adhered to in over 90% of cases

The Neonate in Shock: When to think CARDIAC

Neonates in shock MAY show obvious signs/sx of end-organ dysfunction (similar to adults), but their presentation may be subtle and progress rapidly!

The Sick Neonate

CPR begins when HR <60 in pediatric patient

Resources

Kangaroo Board

The Kangaroo Board was developed by a prominent neonatologist, the head nurse of an NICU, and a head nurse of a labor & delivery unit. The board was created to provide a tool that would give medical professionals an organized system for storage and quick access to all equipment and drugs necessary for the first 10 minutes of infant resuscitation.

NeoResus

NeoResus is a specialized training program that has been designed to standardize the way in which newborn resuscitation is taught in Victoria and other areas of Australia.

Global Library of Women’s Medicine

It is estimated that 5% to 10% of newly born infants will require some degree of active resuscitation for this transition to occur.1 Thus, an individual trained in neonatal resuscitation must be in attendance at every delivery. Furthermore, it is essential that these skilled personnel understand transitional physiology and the basic principles of resuscitation to intervene rapidly when needed in an attempt to prevent any long-term adverse sequelae.

LIFTL

open airway and assess for patency (suction if required). if this baby doesn’t respond quickly will probably need intubation (appropriate size for term neonate = 3.5, intubate and place tip of ETT just beyond cords – ensure adequately ventilating both lungs, length @ lips should be 9cm)

Neonatal Resuscitation Symposium

This symposium provides an opportunity to present research and quality improvement in all areas pertaining to neonatal resuscitation, which may include education, transnational endeavors, simulation and debriefing.

Neopuff

T-piece resuscitation delivers consistent and controlled PIP and PEEP, helping to protect the lungs from injury and also establish and maintain functional residual capacity (FRC).

RebelEM

Call in your friends – get a second team to manage the mother, call OB, call the NICU – all hands on deck