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Neonatal Resuscitation

Author -  <a href='https://www.medindia.net/content-team/dr-harpreet-arora.asp' target='_blank'>Dr. Harpreet Arora, MBBS</a>
Medically Reviewed by <a href='https://www.medindia.net/content-team/dr-simi-paknikar.asp' target='_blank'>dr. simi paknikar, MD</a> on Sep 09, 2015
Medically Reviewed by dr. simi paknikar, MD on Sep 09, 2015


What is Neonatal Resuscitation?

Neonatal resuscitation is the manual help given by the physician to the baby after its birth to help it breathe and heart to beat in emergency situations.


Neonatal resuscitation program thus forms an important part of emergency neonatology. The presence of a neonatologist is compulsory in the labor room during the delivery of a baby. After the birth of the baby, the obstetrician immediately hands over the baby to the neonatologist. The neonatologist assesses the general health status by a score called as Apgar's score and performs neonatal resuscitation if the score is low.

Neonatal Resuscitation

Three to five percent of the 25 million infants born every year in India develop asphyxia during birth. Asphyxia is a condition where there is decreased oxygen and increased carbon dioxide in the body. Blood flow is decreased through the body and is accompanied by a decrease in pH of blood. Asphyxia leads to multi-organ dysfunction that may cause death or lead to neurological complications later in life.

Neonatal resuscitation aims to decrease neonatal death and prevent the development of neurological complications because of asphyxia during birth.

Who Requires Neonatal Resuscitation?

One must carefully evaluate the list of risk factors, in which asphyxia can be anticipated in the coming baby. Some of the babies can be listed out to be the definite candidates of neonatal resuscitation, whereas some babies can be a complete surprise. Thus it is necessary, that every delivery be viewed as emergency and help should be immediately available to resuscitate the baby if necessary.

The risk factors that could increase the chances of the fetus developing neonatal asphyxia can be divided into maternal and fetal, they are as listed:

How to Prepare for Resuscitation and How to Evaluate the Baby?

Every delivery should be considered as an emergency, and the need for neonatal resuscitation should be anticipated irrespective of the pre-existing risk factors. The labor room of the hospital should be equipped with a ready in use radiant heat source to warm the baby, all resuscitation instruments such as suction catheters, meconium aspirators, self-inflating neonatal resuscitation bags, face-masks for both term and pre-term babies, intubation equipment such as laryngoscopes and endotracheal tubes and at least one person skilled in neonatal resuscitation.


As soon as the baby is born, the pediatrician evaluates the baby for resuscitation on the basis of Apgar's score. It takes into account following things: heart rate, respiration, muscle tone, reflex irritability, and color of baby.

A quick way to assess if the baby requires resuscitation is by addressing the following questions.

If answers to all the above questions are "YES", then the baby does not require any resuscitation and is given for routine care that includes cutting the cord, giving warmth to the baby, clearing the airway of baby, drying the baby, and recording vital parameters.

If answers to even one of the above questions is "NO", the baby needs immediate resuscitation.

What is TABC of Neonatal Resuscitation?

TABC are the components of neonatal resuscitation. They stand for Temperature, Airway, Breathing, and Circulation. Let's see each one of them in brief.


Chest compressions are given only in conditions, where heart rate is less than 60 beats per minute despite giving 30 seconds of positive pressure ventilation. It is to be discontinued after heart rate reaches 60 beats per minute or more.

References:

  1. Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - (http://pediatrics.aappublications.org/content/126/5/e1400.full)
  2. Neonatal ehandbook - (http://www.health.vic.gov.au/neonatalhandbook/procedures/resuscitation.htm)
  3. Neonatal Resuscitation - (http://circ.ahajournals.org/content/122/18_suppl_3/S909.full.pdf+html)

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