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Quick Chart
Introduction
  • 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.
Clinical Presentation
  • Refer to SJA Newborn Life Support Flowchart
  • All newborn resuscitations must be transported with active resuscitation to the nearest receiving ED.
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • 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.
Management
Primary Care
  • 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:
    • Supplemental O2 should be delivered when no improvement is evident from effective ventilations on room air.
    • Reduce supplemental O2 when SpO2 reading exceeds 90%.
  • 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
Intermediate Care (EMT / Level 2)
  • 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
Advanced Care (AP)
  • 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
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • 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.

References
References
Key Terms & Links
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