Newborn Life Support - Amplified

Quick Reference

Key Numbers

Physiology

Neonatal resuscitation is fundamentally different from adult resuscitation because:

• Almost always a respiratory problem (not cardiac)
• High surface area → rapid heat loss
• Apnoea response (neonates stop breathing rather than gasp)
• Fluid-filled lungs need inflation breaths to clear

Most babies (9 in 10) need nothing beyond drying and stimulation. Only 1 in 1000 need full resuscitation with compressions.

Preparation (Antenatal)

Communication with obstetric team

Know the risk factors before delivery. Ask: gestation, presentation, meconium, multiple pregnancy, known fetal abnormalities. High-risk deliveries should have a paediatric team present.

Equipment check: warmer, O2, suction, BVM, towels

Before every delivery, check the resuscitaire. Is it on and warm? Is oxygen connected? Is suction working? Do you have the right size mask (size 0/1 for term, smaller for preterm)? Warm towels ready?

Team briefing: roles assigned

If multiple people are present, assign roles before delivery: who does airway, who does compressions, who documents, who gets drugs. Brief the team on expected issues.

At Birth (First 60 Seconds)

Start clock at delivery

Start timing from delivery of the baby. The "golden minute" is your target - aim to have established effective ventilation (if needed) within 60 seconds of birth.

Dry and stimulate

Immediately place the baby on a warm surface and dry vigorously with a warm towel. This provides stimulation and prevents heat loss. Replace wet towels with dry ones. Most babies will respond to this alone and start breathing.

Assess: breathing, heart rate, tone

Breathing: Is the baby making respiratory effort? Crying? Gasping? Heart rate: Feel the umbilical cord base or auscultate. Is it >100, 60-100, or <60? Tone: Is the baby floppy or moving?

If breathing well and HR >100 → routine care with parents. If not breathing or HR <100 → proceed to airway and breathing.

If Not Breathing (Golden Minute)

Airway - Neutral position

Position the head in the neutral position (not hyperextended like adults). A small roll under the shoulders may help. Neonates have large occiputs that flex the neck - avoid this.

Suction if meconium/secretions visible

Only suction if you can see secretions obstructing the airway. Routine suctioning is not recommended - it delays ventilation and can cause vagal bradycardia. If meconium is present and baby is vigorous, no special intervention needed. If meconium and floppy, consider direct laryngoscopy and suction under vision.

5 inflation breaths (sustained 2-3 sec each)

The first breaths are inflation breaths - longer than normal breaths to help open the fluid-filled lungs. Use 30 cm H2O pressure (term) or 25 cm H2O (preterm). Hold each breath for 2-3 seconds. Watch for chest rise.

If no chest rise after 5 breaths:

1. Reposition the head (neutral)
2. Consider two-person jaw thrust
3. Look in the mouth for obstruction
4. Consider oropharyngeal airway or laryngoscopy

If HR <60 After 30 Seconds Ventilation

Circulation - 3:1 ratio

Only start compressions if HR remains <60 despite 30 seconds of effective ventilation (you've seen chest rise). Continuing poor ventilation with compressions is pointless - fix the airway first.

Technique (encircling hands):

• Stand at the baby's feet
• Encircle the chest with both hands
• Place both thumbs on the lower third of sternum (just below nipple line)
• Compress 1/3 of chest depth

Ratio and rate:

• 3 compressions : 1 ventilation
• 120 events per minute total (90 compressions + 30 breaths)
• Count: "One-two-three-BREATHE"

Reassess

After 30 seconds of compressions, pause to check HR. If >60, stop compressions but continue ventilation. If still <60, continue compressions and prepare for drugs.

Drugs (Rarely Needed)

Adrenaline

Only consider if HR remains <60 despite effective ventilation AND chest compressions for at least 30 seconds.

IV/IO route (preferred): 10-30 mcg/kg (0.1-0.3 mL/kg of 1:10,000) ETT route: 50-100 mcg/kg (0.5-1 mL/kg of 1:10,000) - less reliable absorption

Give via umbilical venous catheter if IV needed. May repeat every 3-5 minutes.

Volume

Consider 10 mL/kg crystalloid or blood if suspected hypovolaemia (pale, poor perfusion despite effective resuscitation).

When to Stop

Consider stopping resuscitation if:

• No heartbeat detected after 20 minutes of continuous effective resuscitation
• Discussion with senior team and family
• No reversible cause identified

Document the discussion and decision clearly.