- The term "newborn" refers to the infant in the first minutes to 3 hours following birth.
- The vast majority of babies born at term will initiate spontaneous respirations within 10 to 30 seconds of birth. A small percentage will respond during drying and stimulation. Approximately 10% require ventilation and only about 1% require more extensive chest compressions and medications.
- Refer to Newborn Life Support Flowchart
- All newborn resuscitations must be transported with active resuscitation to the nearest receiving ED.
- Effective airway control and adequate ventilation are the keys to favourable outcomes in newborn patients.
- Hypoglycaemia is evident if BGL is < 2.0mmol.
- Preventing heat loss: Set ambient temperature to minimum of 26°C where possible.
- Follow all steps of the Childbirth clinical skill prior to continuing
- Provide appropriate padding for neutral alignment to open the airway.
- Suction the mouth and nose of the newborn using a Penguin Suction Device or LCSU4 set to the lowest setting to ensure cleared airway. NOTE: Suction is not routinely recommended with newborns and may cause bradycardia and airway damage. Only suction if there is a clear indication for its use, e.g. meconium or blood clots in airway.
- Stimulate baby to induce crying, e.g. rubbing with towel on back.
- The priority is to ensure lung inflation:
- Deliver 3x initial inflation breaths by way of Bag Valve Mask as per clinical skill
- Initial positive pressure ventilation of term newborn patients should be initially delivered via BVM using room air only
- Premature newborn patients (<32 weeks) should be ventilated with blended air (1 litre per minute)
- As expanding the lungs is imperative in newborns, ensure that you get chest rise with initial inflation breaths, if poor response attempt to troubleshoot:
- Two person technique
- Insert an oropharyngeal airway
- Supplemental O2 should be delivered when no improvement is evident from effective ventilations on room air.
- Reduce supplemental O2 when SpO2 reading exceeds 90%.
- Deliver 3x initial inflation breaths by way of Bag Valve Mask as per clinical skill
- Reassess pulse and respirations
- If pulse < 60 beats per minute:
- Commence chest compressions (using 2 thumb encircling technique where possible; if there is only one responder, the 2 finger technique is recommended) at 3:1 compression to ventilation ratio
- Ventilate using high-flow oxygen via BVM
- Reassess for change every 2 minutes
- If pulse between 60 - 100 beats per minute:
- Ventilate with high-flow oxygen at 40-60 breaths per minute (1 every 1 to 1.5 seconds) until pulse exceeds 100 beats per minute
- Reassess breathing and pulse every 30 seconds
- If pulse > 100 beats per minute:
- Progress with Childbirth clinical skill, assessing APGAR at 1, 5 and 10 minutes
- If pulse < 60 beats per minute:
- Monitor both maternal and newborn patients persistently, recording full observations as often as practicable (aiming for every 5 minutes)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
- Newborn Life Support as per flowchart
- Cardiac Arrest
- Insert supraglottic airway device
- Establish IO access; if IO access cannot be obtained, continue resuscitation efforts without medications
- Medication administration (if weight unknown, assume 3.5kg [Paediatric Drug Calculator])
- Ensure saline flush is 3-5ml only
- Fluid therapy as per CPG
- Adrenaline as per CPG
- Glucose as per CPG (only if cause for low BGL is strongly suspected, if BGL <2.0mmol/L)
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport
- Priority 1 to nearest obstetric unit if patient time critical
- To booked obstetric unit if patient stable
- Pre-notify receiving facility in both circumstances
- As per Advanced Care guidelines
- Termination of Resuscitation requires an ASMA consult via CSP in SOC.
- Cardiac Arrest Secondary to Hypothermia:
- Hypothermia in Western Australia as a cause of cardiac arrest is extremely rare and mostly accidental e.g. locked in a cool room. If you suspect that the cardiac arrest was secondary to hypothermia, the emphasis is on high performance CPR and transport.
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