Download Neonatal resuscitation

Neonatal resuscitation
Recommend
 See Immediate management flowchart
 If time allows always prepare neonatal resuscitation equipment items prior to delivery in the order in
which they would be used (see flowchart)
 Always establish and maintain adequate ventilation before considering and administering neonatal
naloxone
 Never administer neonatal naloxone to the infant of a mother with narcotic addiction (or on methadone
maintenance). Sudden reversal of chronic narcotic action can cause severe life-threatening withdrawal
symptoms, including refractory seizures
Background
 Neonatal resuscitation equipment is required in all facilities in the event of unplanned delivery
 The most important interventions in neonatal resuscitation are ensuring the infant’s airway is open and, if
the infant is not breathing, providing effective positive pressure ventilation
 If a mother received narcotics within 4 hours of birth, her newborn may experience some degree of
respiratory depression due to transplacental drug effect
 Neonatal naloxone is not a resuscitation drug
1.
May present with:

Unresponsive newborn

Newborn with low or absent heart rate

Newborn with poor colour - blue / white

Absent respiratory effort

Limp newborn

Meconium
2.
Immediate management:
 Call for help
 Consult Medical Officer urgently
 See neonatal resuscitation flowchart for immediate management
Important clinical observations - heart rate over 100 bpm / spontaneous breathing /
temperature is > 36.5° C
[8]
3.
Clinical assessment:
 Perform clinical observations including:

assess breathing, heart rate (use paediatric stethoscope) and colour

assess baby’s tone
 Take temperature (unless resuscitation is required, in which case, use measures to maintain infant’s
body temperature and take temperature after resuscitation)
4.
Management:
 Surround baby with a warm blanket, but make sure you can see the face, neck and chest
 Place baby flat on back or side with head towards and feet away from you on neonatal resuscitation
trolley (or equivalent with overhead heater)
 Ensure that the baby’s head is in a position to allow an open airway – head midline and neither very
flexed or extended
 Wipe the baby dry
 Clear the airway, using suction if required
 Provide resuscitation measures according to the Neonatal Resuscitation Flowchart
 Note that oxygen is not usually required unless the baby remains centrally cyanosed at 5 minutes of
age, or unless ventilation plus chest compressions are needed. The priority is to establish breathing
and heart rate, rather than to give oxygen
 If mother has been given Pethidine soon before birth, it may be appropriate to give IM or IV neonatal
naloxone to a baby who has low tone and does not establish regular breathing after other effective
resuscitation measures have been applied. Naloxone is never indicated if adequate ventilation of the
lungs and adequate heart rate has not yet been achieved
DTP
Mid / IHW / NP / IPAP / RIN
Rural and Isolated Area Registered Nurses, Authorised Indigenous Health Workers and Isolated Practice Area Paramedic must
consult MO
Midwives may proceed
Nurse / Midwife Practitioners may proceed
Route of
Recommended
Restrictions /
Form
Strength
Duration
Administration
Dosage
Condition
Ampoule
0.4 mg/mL
IM
Neonate:
Can be repeated every 2Maximum 0.4mg
IV
0.1 mg/kg
3 mins only on MO’s
orders
Provide Consumer Medicine Information if available:
Management of Associated Emergency: consult MO
[9] Note - opiate analgesics have a longer duration of action than Naloxone and respiratory depression may return
Schedule
4
Naloxone hydrochloride
as the Naloxone wears off. Continued observation and monitoring of respiratory function in the newborn is essential
5.
Follow up:
 Unplanned delivery in facilities where planned births do not take place should be subsequently
managed in referral hospital
 It is important post delivery to establish bonding and breast feeding
 The health of the neonate will determine follow up when returning home but will include seeing Child
Health Nurse regularly and MO at 6 weeks
 For baby of women with diabetes in pregnancy close neonatal monitoring is required
6.
Referral / consultation
 Consult MO urgently on all occasions where neonatal resuscitation is required