History:

 

• Due date and gestational age
• Multiple gestation (twins, etc.)
• Meconium
• Delivery difficulties
• Congenital disease
• Medications (maternal)
• Maternal risk factors
  • Substance abuse
  • Smoking

 

Significant Findings:

 

• Respiratory distress
• Peripheral cyanosis/mottling (normal)
• Central cyanosis (abnormal)
• Altered level of responsiveness
• Bradycardia

 

Differential:

 

• Airway failure
  • Secretions
  • Respiratory drive
• Infection
• Maternal medication effect
• Hypovolemia
• Hypoglycemia
• Congenital heart disease
• Hypothermia

 

 Treatment:

 

• Suction mouth and then nose
• Keep baby at level of the vagina until cord is cut
• Clamp and cut cord
• Record infant APGAR
• Dry the infant, keep infant warm
• use tactile stimulation to rouse the infant

 

 

Respirations present ?

 

• No

 

• • Position infant supine or on side with neck in neutral position
  • BVM 30 sec at 40-60 breaths/min with room air

 

• Yes

 

Heart Rate < 100 with persistent cyanosis ?

 

• Yes

 

• • Position infant supine or on side with neck in neutral position
  • BVM 30 sec at 40-60 breaths/min with room air

 

• No

 

• • Continue to monitor
  • Reassess 5 min APGAR
  • Continue Oxygen

 

Heart Rate < 60 ?

 

• Yes

 

• • Begin CPR for 2 min or until spontaneous heart rate > 80

 

 

Improvement?

 

• Yes

 

• • Continue Oxygen
  • Continue to monitor
  • Reassess 5 min APGAR

• • Initiate IV

 

• No

 

• • Intubate and ventilate 1 min; continue CPR

 

• • Initiate IV/ IO

 

• • Epinephrine 0.01 mg/kg (0.1 mL/kg) IV/IO

 

• • Normal Saline 20 mL/kg IV/IO; max 60 mL/kg or 1,000 mL
  • 10% Dextrose (D10) 5-10 mL/kg IV/IO

 

 

Heart rate 60-100 ?

 

• Yes

 

• • Continue Oxygen
  • Continue to monitor
  • Reassess 5 min APGAR

• • Initiate IV

• • Notify receiving facility or contact Medical Control

 

PEARLS:

 

• Neonate = birth to 1 day.
• Maternal sedation or narcotics will sedate the infant.
• CPR 100-120 compressions per minute and at a depth of no less than 1/3 of anterior/posterior diameter of chest with interruptions less than 5 seconds.
• If HR is persistently < 60 to consider hypovolemia and pneumothorax as possible easily reversible causes of unsuccessful resuscitations.

 

Apgar Score

 

• A score is given for each sign at one minute and five minutes after the birth.
• If there are problems with the baby an additional score is given at 10 minutes.
• A score of 7-10 is considered normal
• 4-7 might require some resuscitative measures
• baby with APGARS of 2 and below requires immediate resuscitation.