Chapter 52. Neonatal resuscitation and transport
Cardiac arrest in a neonate (a baby less than 1 month old) may present from:
• A planned home delivery
• An unplanned birth before arrival in hospital
• An infant who has a normal birth and is discharged home and thereafter becomes ill.
The general principles remain the same:
Support of airway (A), breathing (B) and circulation (C).
Neonatal resuscitation
In most instances, the baby born outside hospital will not require any advanced interventions. If the baby is active with a normal respiratory rate and heart rate, then the only treatment required will be to dry and warm the baby, and to use suction as required. A small number of babies will require more active resuscitative measures. Hypothermia is very common and must be avoided, as it leads to poor outcomes.
Meconium
• Fetal distress during labour leads to contamination of the amniotic fluid with meconium from the baby’s gastrointestinal tract
• Wait for the baby to be fully born before applying suction
• The baby will require careful suction after the body is delivered to ensure that no further meconium is aspirated into the trachea and lower airways: the morbidity and mortality rates from meconium aspiration syndrome remain high.
Apgar scores
This system assesses the baby’s overall condition at 1 minute and 5 minutes after birth and later if required. Resuscitative measures should be started immediately, however, and not delayed for evaluation of the Apgar score.
Neonatal basic life support
• The first measure is to stimulate the child. This occurs during drying and warming, and by suctioning of the nasopharyngeal and oropharyngeal passages
• This is often enough to increase the child’s respiratory rate which, as a result of better oxygenation, increases the cardiac rate
• If, after a short period of stimulation, the clinical situation remains grave, the next measure is to maintain the airway by placing the baby in a supine position with the neck in a neutral position, thus avoiding hyperextension (a folded towel under the shoulder can facilitate this)
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
