Algorithm for resuscitation of an asphyxiated newborn baby

Birth
Note the time
Put on the stop clock

Is baby breathing or crying?

No Yes
Routine care
Cut cord immediately place the baby on
Place under radiant warmer mother’s abdomen
Position, clear airway dry the baby
Dry stimulate reposition

Gasping or apneic or No Clean the oral cavity & nose

HR <100 bpm with a gauze piece or suction
Cut cord after 1-2 min
Yes
Provide PPV using room air Transfer under a radiant
and SpO2 monitoring warmer & do ongoing evolution

No (breathing spontaneously
HR <100 bpm after 5 inflations & HR > 100 bpm)

Yes

No chest rise on PPV Consider CPAP

Reposition, HR>60bpm Preterm baby
Open airway, Labored breathing
Reduce leaks Law SpO2
Consider intubation &
Increasing pressure

HR <60 bpm

PPV with 100% O2 HR> 60bpm continue ventilation till HR>100

chest compression bpm & SpO2 is normal for age

HR> 60bpm

Administer epinephrine
Volume expansion slowly
Over 5 -10 minute

HR< 60bpm or persistently low SPO2

Consider & manage Post resuscitation care in the NICU

Airway malformation
Pneumothorax
Diaphragmatic hernia
Hyaline membrane disease
Congential heart disease
Hypovolemia, shock or severe acidosis
Congenital complete heart block

**** Endotracheal intubation may be considered at several steps.