LECTURE 5:

ADVANCED
RESUSCITATION

MODULE 5: Newborn Resuscitation

 At the end of this activity, the participants will
be able to:

⚫ Recognize the need for chest

Objectives compression.
⚫ Perform coordinated chest compressions
and positive pressure ventilation.
⚫ Recognize the need for umbilical vein
catheterization and medications.
⚫ Know when to stop resuscitation.
 9. Ventilation corrective steps
10. Intubate if needed
Heart rate remains
less than 60 beats per HR < 60
Indication for minute (bpm) despite bpm?
Chest 30 seconds of
YES
Compressions effective
positive-pressure 10. Intubate if not already done
ventilation 11. Coordinated PPV and chest
compressions
12. 100% O2
13. Consider UVC insertion
 9. Ventilation corrective steps
10. Intubate if needed

Indication for HR < 60

Chest bpm?
COVID-19
Compressions YES Precaution
10. Intubate if not already done
• Stop chest
11. Coordinated PPV and chest
compression
compressions
while ongoing
12. 100% O2
intubation to
13. Consider UVC insertion
reduce
aerosol
generation
Chest
Compressions

Link to hi-res video: Chest compressions

 2 People Needed
⚫ One person compresses chest
⚫ One person continues ventilation

Personnel
Chest
Compression:
Thumb
Technique
Chest
Compression:
2 Finger
Technique
 ⚫ Apply pressure
during
compression on
the sternum,
Chest then release
Compressions: pressure to allow
Pressure and chest recoil and
Depth ventilation

⚫ Depress sternum
1/3 of AP
diameter of the
chest
 7. PPV
8. SpO2 monitoring

Apnea /
gasping NO
or HR < 100
bpm?

YES
9. Ventilation corrective steps
After 60 seconds of 10. Intubate if needed
Stopping compressions and
Compressions ventilation, stop and NO HR < 60
check heart rate bpm?

YES
10. Intubate if not already done
11. Coordinated PPV and chest
compressions
10. 100% O2
11. Consider UVC insertion

NO HR < 60
bpm?

YES
14. IV epinephrine
15. Consider hypovolemia
16. Consider pneumothorax
 10. Intubate if not already done COVID-19
11. Coordinated PPV and chest
compressions
Precautions
10. 100% O2
11. Consider UVC insertion
• IV is the
Epinephrine preferred
route for
Administration HR < 60 epinephrine
bpm?
• Medications
YES given via ET
14. IV epinephrine are
15. Consider hypovolemia aerosol-gener
16. Consider pneumothorax
ating
 When the heart rate remains below
60 beats per minute despite

⚫ 30 seconds of assisted ventilation

Epinephrine followed by
Indications ⚫ 60 seconds of coordinated compressions
and ventilation
_____________
Total = 90 seconds
Umbilical
Vein
Catheter
Insertion
 Dilute 1:1000
concentration
Epinephrine: 0.1 to 0.3 ml/kg of 1:10,000 solution
to 1:10,000
Dosing (consider 0.5 to 1 ml/kg if giving via
endotracheal tube)
Epinephrine:
Administration
 ⚫ Increases strength and rate of cardiac
contractions

Effects and ⚫ Causes peripheral vasoconstriction

Repeated
dosing of ⚫ Repeat doses should be given via umbilical
vein, if possible
Epinephrine
⚫ Repeat dose via umbilical vein if first dose
given via endotracheal tube
 Recheck effectiveness of
Poor ⚫ Ventilation
⚫ Chest compressions
Response to
⚫ Endotracheal intubation
Epinephrine ⚫ Epinephrine delivery
(Heart Rate
< 60 bpm) Consider possibility of
⚫ Hypovolemia
 Baby is not responding to resuscitation

AND

Appears in shock
Indications ⚫ pale color, weak pulses, persistently
low heart rate, no improvement in
for Volume circulatory status despite
resuscitation efforts
Expansion
History of a condition associated with fetal
blood loss
⚫ extensive vaginal bleeding, abruptio
placentae, placenta previa,
twin-to-twin transfusion
 ⚫ Recommended solution = Normal saline

⚫ Recommended dose = 10 mL/kg

Volume
Expanders ⚫ Recommended route = Umbilical vein

⚫ Recommended rate = Over 5 to 10 mins

 Expected signs of volume expansion
⚫ Heart rate becomes normal
Expected ⚫ Pulses stronger
Response: ⚫ Pallor lessens
Volume
Expanders Follow up if hypovolemia persists
⚫ Repeat volume expanders (dose 10
mL/kg)
 ⚫ Discontinuation of resuscitation efforts may
be appropriate after 10 minutes of absent
heart rate following complete and adequate
When to resuscitation efforts.
STOP ⚫ The decision to continue or discontinue
resuscitative efforts must be individualized.
LECTURE 5:

ADVANCED
RESUSCITATION

MODULE 5: Newborn Resuscitation