You are asked by the triage nurse to evaluate a pregnant patient whose water broke and is experiencing contractions. Over the course of the next 45 seconds, you find yourself holding a newborn boy. He’s limp, apneic and not making a sound. Besides reaching for the panic button, what else can you do?

Forget ACLS! Remember, this is a neonate.

First, ask yourself 3 questions: Term birth? Crying or breathing? Good muscle tone?

If you cannot answer yes to any of these questions: warm the patient, clear the airway, stimulate (while drying, or flicking the feet).

Next, keep in mind respiratory status is much more of a priority for neonates. The next steps in the sequence include: ventilation (positive pressure), then intubation/compressions, then epi (0.01-0.03 mg/kg/dose) and volume expansion (10 cc/kg). (Re-familiarize yourself with NALS below)


What’s the best way to get IV access? Umbilical vein cannulation!

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[Inspired by today’s morning report with Dr. Michelle Vasquez, PEM Fellow]


Kattwinkel et al. Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. PEDIATRICS Vol. 126 No. 5 November 1, 2010.