1. EMS
Resuscitation of the
Newborn
Jim Morgan , D.O. FAAEM
Emergency Medicine
EMS Medical Director
Joplin, MO

2. Epidemiology

10% of newborns will require “assistance”
when they’re born

Incidence of complications increase as




Birth weight decreases
Prenatal problems increase
Prenatal age decreases
Look for antepartum & intrapartum issues

3. Physiology

Prior to delivery, newborn lungs filled with
fluid

Capillaries & arterioles of lungs are
closed

Blood pumped by heart bypasses lungs
thru ductus arteriosis

4. Ductus Arteriosis

5. Physiology

During delivery (or shortly after), the
newborn begins using lungs




Compression of chest removes fluid
Sudden inspiration causes air movement to
displace fluid
Resistance thru lungs decreases & blood flow
preferentially bypasses ductus
Ductus closes & becomes ligamentum
arteriosum

6. Initial Care

Airway



Maintain at level of mother’s vagina
Bulb suction
Gentle stimulation

Assess initial APGAR score

Prevent heat loss





Gently dry
Swaddle in warm receiving blanket
Avoid air drafts
Skin-to-skin with mother
Cutting umbilical cord



Do not milk the cord
Clamp 30 seconds after delivery
Clamp ~ 4 cm from newborn

8. At Birth

Is newborn full-term?

Is newborn breathing &/or crying?

Does newborn have good muscle tone?

9. At Birth

Is meconium present?



Thin meconium
Thick meconium
Assess O2 saturation


60 – 70% at birth
May take 5 – 10 minutes to reach > 95%

Cyanosis common esp. acrocyanosis

HR ~ 150 – 180 slowing to 130 – 140

HR < 100 abnormal – begin resuscitation

10. The Distressed Newborn

11. Inverted Pyramid of
Resuscitation

12. Basic “Resuscitation”

Initial care






Drying
Warming
Positioning
Suctioning
Tactile stimulation
Assessment



Respiratory effort
Heart rate
Color

13. Airway

Ventilation





Use neonatal BVM with pop-off valve
with supplemental oxygen



HR < 100
Apnea
Poor O2 saturation
Persistence of central cyanosis
Ventilate @ 40 – 60 bpm
Ventilate @ ~ 35 – 45 cm H2O
OR adequate chest rise
Supplemental oxygen

100% oxygen in the field

14. Neonatal Ambu Bag

15. Airway

Consider intubation




Chest compressions
Difficult to ventilate
Thick meconium
Inadequate response

16. Chest Compressions

Encircle chest with both hands & use
thumbs

Compress lower half of sternum @ 100
per minute

Discontinue if HR increases to > 80

17. Vascular Access

MOST distressed newborns respond to
initial care, ventilation, & chest
compressions

If vascular access needed, can use
umbilical catheter


Umbilical cord with 2 arteries & 1 vein
Insert catheter into vein & secure with
umbilical tape

18. Medications

Naloxone


Glucose



Do not use in newborn resuscitation
No specific glucose level at birth can be agreed upon
Prehospital glucose administration difficult
Epinephrine

0.05 - 0.1 mg/kg

(0.3 to 1 mL/kg of a 1:10,000 solution)

19. Specific Neonatal
Situations














Meconium-stained amniotic fluid
Apnea
Diaphragmatic hernia
Bradycardia
Prematurity
Respiratory distress/cyanosis
Hypovolemia
Seizures
Fever
Hypothermia
Hypoglycemia
Vomiting
Diarrhea
Common birth injuries

20. Congenital heart conditions







Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Tetralogy of Fallot
Transposition of the great vessels
Coarctation of the aorta
Pulmonary stenosis
Aortic stenosis

21. Failure to respond

Mechanical blockage


Impaired lung function




Pneumothorax
Diaphragmatic hernia
Pulmonary atresia
Central cyanosis


Meconium
Congenital heart disease
Apnea


Brain injury
Neuromuscular disease

22. Enroute to the call

Review how you will handle


Normal birth & newborn
Newborn in distress

Warm patient compartment

Consider possibility of needing back-up
personnel

23. Remember….

Most newborns will respond to minimal intervention

If meconium is present AND…



Child is vigorous, light suctioning
Child is flaccid, may need ETT + suction
If HR



> 100, supplemental oxygen
Between 60 – 100, positive pressure ventilation
< 60, chest compressions

Rarely…..epinephrine thru umbilical vein

Reassess every 30 seconds

24. Questions?