Neonatal Resuscitation

Newborns go through a complex set of physiologic changes to successfully transition to extrauterine life. These changes quickly shift responsibility for gas exchange from the placenta to the newborn’s lungs. The infant’s initial breaths and respiratory effort are the catalyst; they drive up intrapulmonary pressures and help clear fetal lung fluid. Increased blood oxygen content decreases pulmonary vascular resistance, increases pulmonary blood flow, and facilitates closure of the foramen ovale and patent ductus arteriosus, which previously shunted blood away from fetal lung circulation. Just as a newborn’s efforts at ventilation are key to a successful transition after birth, the most important part of newborn resuscitation is effective ventilation.

In 2015, the Neonatal Resuscitation Program (NRP) published updated guidelines for neonatal resuscitation. Key additions to the 2015 NRP algorithm include consideration of using 3-lead electrocardiography (ECG) to monitor heart rate (HR) and initiating intubation before chest compressions. The guidelines now recommend that providers 1) do not routinely intubate for tracheal suctioning in the setting of meconium aspiration, 2) ensure thermoregulation of all newborn infants between 97.7°F and 99°F (36.5°C and 37.5°C), and 3) delay cord clamping for all vigorous newborns.

The updated NRP algorithm (Figure) begins with a basic risk assessment by the clinician, asking if the baby is term, is crying or breathing, and has good muscle tone. If the answer to all of these questions is yes, the baby should be placed skin to skin with the mother with continued observation. If the answer to any of the questions is no, providers should move the infant to a radiant warmer and warm, dry, and stimulate the infant. If needed, …