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from Section 2 - Basics in cardiopulmonary resuscitation of newborn infants
Published online by Cambridge University Press: 05 March 2012
Rapid initial assessment (0–30 s after birth) and stimulation
After birth, assessment of breathing and heart rate is done rapidly (see p. 131, pp. 142–9, pp. 150–3), as follows:
Palpate the umbilical cord or auscultate the heart: HR >100 bpm? Assistant may tap out HR for other resuscitators
Is meconium visible? (Check in particular for staining of cord stump and nail beds)
Suction (first mouth, then nose), if needed (see pp. 66–9)
Dry and thereby stimulate breathing/keep warm (certain exceptions may apply)
If still pale/cyanotic/insufficient breathing, proceed to stimulation (with four fingers while drying the back, may also rub the soles of the feet and sternum)
O2 supplementation as needed if SpO2 <85%–90% (FiO2 0.21–1.0, flow 5 1/min)
If there are signs of severe neonatal compromise/terminal (aka: secondary) apnea present, perform PPV (see below)
Oxygen supplementation
Postnatally administered oxygen (via hood, mask, phargngeal-CPAP, intubation/PPV) is a very effective “drug” (oxygen decreases PVR, increases pulmonary blood flow and oxygenation, and induces ductus constriction).
! If the SpO2 is rapidly improving during initial newborn care, oxygen supplementation must be continuously reduced or stopped, since high PaO2 levels/oxygen radicals reduce cerebral blood flow, induce myocardial and renal tubular damage, and promote the development of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) in preterm infants.
! In most cases, there is no need to provide a newly born infant with additional oxygen in the delivery room if preductal SpO2 is reliably >85%–90% (i.e., no meconium aspiration, sepsis/pneumonia, CDH or other causes of impaired lung function and PPHN).
At 5 min of life, approximately half of newborns in room air have SaO2 of 90%. […]
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