What Is a Neonatal Resuscitation?

Neonatal resuscitation flowchart, mainly explaining the steps of newborns during resuscitation, and judgment criteria.

Neonatal resuscitation flowchart

The neonatal resuscitation flowchart mainly explains the steps of a newborn during resuscitation, and the judgment criteria required during rescue. For today's neonatal disciplines, the neonatal resuscitation flowchart has outlined the required directions ^[1]

The neonatal resuscitation flow chart is divided into three 30 seconds. The first 30 seconds need to be done:

(1) Quick assessment: (first 30 seconds)

Quickly evaluate 4 indicators immediately after birth in a few seconds:

1. Full term?

2. Amniotic fluid clear?

3 Are you crying or breathing?

4 Is the muscle tone good?

If one of the above 4 items is "Yes", the initial evaluation can be performed and the routine care can be performed.

Routine care: 1. Maintain body temperature (requires irradiation bed or incubator)

2. Clean up the airway (if meconium, use meconium suction tube, if normal, go to the next step)

3. Dry the whole body (requires warm towels, etc.)

If one of the above four items is "No", the following preliminary recovery is performed.

(2) Initial recovery: (second 30 seconds)

1. Keep the newborn on a radiant warmer or take measures to keep warm, such as using a pre-heated blanket.

Wrap the newborn to reduce heat loss, etc. Conditional medical units can place their bodies and limbs below the head in clean plastic bags for very low birth weight (VLBW) children weighing <1500g, or cover them with plastic film on a radiation warmer. Continue with other steps of initial recovery. Avoid high temperatures due to respiratory depression.

2. Body position The newborn's head is slightly supine (nasal inspiratory position).

3. Attract the midwife to squeeze out the secretions in the oropharynx and nose of the newborn by hand before shoulder delivery. After giving birth, use a suction ball or straw (12F or 14F) to clear the secretions first after oropharyngeal and then nasal. Excessive suction may cause laryngospasm and vagal bradycardia and delay spontaneous breathing. The depth of the suction tube and the suction time (<10s) should be limited, and the negative pressure of the suction device should not exceed 100mmHg (13.3kPa).

Treatment of amniotic fluid with meconium contamination: When amniotic fluid is contaminated with meconium, no matter if the meconium is thick or thin

First assess the newborn's vitality: when the newborn is viable, continue the initial recovery; if not, use a meconium suction tube for intratracheal suction.

* Definition of vitality: regular breathing or crying loud, good muscle tone and heart rate> 100 beats / min. If one of the above 3 items is not good, it is inactive.

4. Wipe dry and dry your body quickly, remove the wet towel.

5. Stimulate the foot of your newborn or flick your fingers twice with your fingers or rub your back to induce spontaneous breathing. If these efforts are ineffective, the newborn is in secondary apnea and needs positive pressure ventilation.

After the above steps, you can make the first 30-second evaluation and the second 30-second evaluation. You need to evaluate breathing, heart rate, and skin color. *Evaluation

1. Spontaneous breathing: heart rate> 100 and ruddy, can be observed and processed.

2. For apnea or <100, perform artificial respiration treatment. If effective ventilation, heart rate> 100 and ruddy, you can do post-resuscitation care.

If the neonatal heart rate is <60, a third 30-second judgment is required.

3. If cyanosis occurs, you need to give oxygen first, if you can breathe spontaneously, heart rate> 100 and ruddy, you can observe and treat, if oxygen is not effective, and continuous cyanosis appears, artificial respiration is needed, if effective ventilation, heart rate> 100 and Ruddy, you can do post-recovery nursing work. If the neonatal heart rate is <60, a third 30-second judgment is required.

(Three) positive pressure ventilation (the third 30 seconds)

1. If the heart rate is <60, positive pressure artificial respiration is required *. If the positive pressure artificial respiration is used, the heart rate is> 60, then artificial respiration treatment is performed. If effective ventilation, the heart rate is> 100 and ruddy, you can do post-resuscitation care. . If not, you need to proceed to the next step!

2. After the above steps, if the heart rate is still <60, you need to use adrenaline for rescue. If the rescue is successful, artificial respiration is needed. When the heart rate is> 100 and ruddy, you can do post-resuscitation care.

3. When performing the third step, check the validity of the following steps:

• Normal artificial respiration

• Chest compressions

• Tracheal intubation

• Give adrenaline

  * In considering these steps, consider using an endotracheal tube.

  !! The most important and effective measure for neonatal asphyxia is positive pressure artificial respiration.

  The following possibilities need to be considered:

• Low blood volume

If the heart rate is <60 or continuous cyanosis or artificial respiration fails, the following points need to be considered:

• Tracheal malformation

• Chest problems, such as: (pneumothorax, diaphragmatic hernia);

• Congenital heart disease

  * If the above steps (3 30 seconds) have been completed, the inspection has been completed, the newborn has no heartbeat or> 10 minutes, then you may consider stopping resuscitation!