Neonatal Resuscitation.

(Some descriptors for reference: Terrifying. Scary. Fear-inducing. Horrific. Chilling.)

But fear not! Your TR pearl today is brought to you by the NICU rotation + Jillian Nickerson/T.Webb doing some excellent preparatory work for/with you.

So there’s this thing called the NRP — Neonatal Resuscitation Program. It different from PALS mainly that it pertains solely to the brand newest humans on the planet. So lets get into it…

  1. First great thing is that babies are typically super resilient. Most babies just need a little TLC (cuz they’re not IRL ready yet) and they do fine. Only about 1% of babies born will end up needing full resuscitation outside of airway support (hooray!). BUT if they need a little help, get your NICU consult on the case with you ASAP!
  2. the “GOLDEN MINUTE”
    • Warm and maintain body temperature. (put that baby in the hot box and blankets blankets blankets!!!)

    • Position airway and clear secretions if needed

    • Dry the infant

    • Stimulation – Tactile stimulation of the newborn is initiated promptly after birth (should not exceed more than 30 secs)

  3. The scary part — apnea and/or HR < 100
    • Positive pressure ventilation (PPV) via BVM@ RR 20 (q3sec)
      • MAXIMIZE oxygenation with MR SOPA
        • Mask readjustment
        • Re-position the head/neck
        • Suction/Secretion control
        • Open the mouth
        • PIP — add on some pressure (max of 40mm H2O)
        • Advanced airway (if no improvement/response after 15 – 30 seconds)
    • PulseOx monitoring: remember that newborns aren’t ready for IRL just yet so your expected SpO2 are as followsTarget Saturations in Newborns
    • Look for response:
      • HR> 100 bpm + spontaneous breaths –> can d/c BVM and monitor closely with chased target SpO2.
      • HR < 100 bpm –> continue PPV/BVM and readjust for maximal oxygenation & ventilation
      • HR < 60 bpm (considered a coding infant) –> start compression @ rate of 100-120 bpm (wrap around technique), SECURE THE AIRWAY (meaning intubation time!)
      • neonatal chest compression technique
  4. Intubation

Pediatric Intubation Chart        5. Access

  • reach for your IO (Pink is for Peds!) or Umbilical Vein Catheter (from NICU or Peds ED)
  • EPI EPI EPI!

For more information, check out:

https://www.aap.org/en-us/continuing-medical-education/life-support/NRP/Pages/About.aspx (NRP website with info on courses, materials, and mission)

https://eccguidelines.heart.org/wp-content/themes/eccstaging/dompdf-master/pdffiles/part-13-neonatal-resuscitation.pdf (its a long pdf, if you’re into that)

Your PGY3 NICU rotation — seriously guys, there’s some essential & good stuff to know about cute new babies. Not to be missed.

May 2022
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