Newborn Resuscitation at Time of Delivery

Perform the following procedures in a stepwise fashion as indicated.
Reassess after each step before proceeding to the next.

 

BLS

 

  1. A. If infant is apneic, gasping, or has a HR < 100/min begin Positive Pressure Ventilation (PPV) with a bag-valve-mask (infant preferred) at rate of 40-60 breaths per minute for 30 seconds. (Caution: risk of barotrauma – bag only enough for chest rise and fall.) Positive pressure ventilation and thermoregulation are the most important priorities in newborn resuscitation.
  2.  

    1. Start oxygen saturation monitoring with pulse oximeter, if available.
    2.  

    3. Consider 3-lead EKG monitoring to determine heart rate
    4.  

    5. Begin resuscitation with 21% oxygen.

     

  3. Reassess after 30 seconds of PPV:
  4.  

    1. If HR is < 100/min but > 60/min PPV, ensure good seal and airway position. Continue to perform PPV.
    2.  

    3. If HR < 60/min, begining chest compressions with a ratio of 3:1 compressions to breaths (90 compressions and 30 respirations per minute)
    4.  

  5. If HR >100/min, transport to closest pediatric facility with continued close monitoring
ALS

 

  1. If infant is apneic, gasping, or has a HR < 100 begin Positive Pressure Ventilation (PPV) with a bag-valve-mask (infant preferred) at rate of 40-60 breaths per minute for 30 seconds (Caution: risk of barotrauma – bag only enough for chest rise and fall.) Positive pressure ventilation and thermoregulation are the most important priorities in newborn resuscitation.
  2.  

    1. Start oxygen saturation and heart rate monitoring with pulse oximeter, if available
    2.  

    3. Consider 3-lead monitoring
    4.  

    5. If available, begin resuscitation with 21% oxygen.

     

  3. Reassess after 30 seconds of PPV:
  4.  

    1. If HR is < 100/min but > 60/min, ensure good seal and airway position. Continue to perform PPV.
    2.  

    3. If HR < 60/min begin chest compressions with a ratio of 3:1 compressions to breaths (90 compressions and 30 respirations per minute)
    4.  

      1. Reassess after additional 30 seconds of PPV and compressions. If HR < 60 BPM, administer epinephrine 0.01mg/kg of 1:10,000 IV/IO and continue compressions and ventilation.
      2.  

      3. Reassess after additional 30 seconds. If HR still < 60 bpm, administer 0.9% NS bolus 10ml/kg, slow IV push over 5-10 minutes.

     

  5. If HR does not improve despite performance of good PPV, intubate or use supraglottic airway. Use meconium aspirator to suction thick secretions only if there is evidence of meconium airway obstruction.
  6.  

  7. If continued HR <100/min then intubate or place a Supraglottic Airway
  8.  

  9. If HR >100/min, transport to closest pediatric facility with continued close monitoring. Newborns are very prone to hypothermia even in summer months. Use warmed blankets and newborn cap.
Targeted Preductal SpO2 After Birth
1 min
60% - 65%
2 min
65% - 70%
3 min
70% - 75%
4 min
75% - 80%
5 min
80% - 85%
10 min
85% - 95%

Newborn Resuscitation Flow Chart