Paediatrics: Newborn life support

Neonatology

Newborn life support

All who attend deliveries should be proficient in newborn resuscitation, ideally taught on a recognized course (newborn life support (NLS) or equivalent). The algorithm on demonstrates a general approach to resuscitation (see Fig. 6.1). Preterm infants require special consideration.

Before birth

·  Check equipment.

·  Ask about: Gestation? Foetal distress? Meconium?

At birth

·  For uncompromised babies, a delay in cord clamping of at least one minute is recommended.

·  There is insufficient evidence to recommend a delay in babies who require resuscitation.

Meconium

·  Vigorous infants born through meconium stained liquor do NOT require airway suctioning either on the perineum or the resuscitaire.

·  Pale, floppy, poor respiration, or bradycardia? Inspect oropharynx and perform suction if required.

·  If appropriate expertise is available, tracheal intubation and suction may be useful in non-vigorous babies. If expertise not available, or if attempted intubation is prolonged or unsuccessful, start mask ventilation, particularly if there is persistent bradycardia.

Lung inflation

·  Inflation breaths are given initially, use air (21% O₂).

·  3s each breath, 7 30cmH₂0 (term infants)—give in sets of 5.

·  Once the chest is moving, ventilation breaths (shorter and gentler) are given at a rate of 30–40/min if required.

Airway manoeuvres

·  Jaw thrust (2 person technique very useful).

·  Direct inspection of oropharynx and airway suction.

·  Guedel airway.

·  Intubation (if competent).

Chest compressions

·  Rate 7100/min, using two thumbs technique.

·  3 chest compressions per lung inflation (3:1 ratio).

·  Re-assess infant after each 30secs (15 cycles).

Drugs

·  Give through umbilical venous catheter (UVC) or IO (high dose endotracheal tube (ETT) adrenaline can be considered).

·  Remember, drugs are B.A.D. (Bicarbonate/Adrenaline/Dextrose 10%).