SET UP equipment

3. flowmeter 5-10;
21% PPV

1. switch on light;
I

2. regulator 100mmHg suction;

4. O2 blender

Newborn!
INITIAL ASSESSMENT for breathing, tone, term / pre-term & meconium

If yes, stay with mother for skin to skin and breastfeeding

If no, proceed with neonatal resuscitation

INITIAL RESUSCITATION:
1. Warm
2. Dry towel-wipe back and front thoroughly
3. Suction cover open-end of tube, then insert other tube to drain
oropharynx, then nose
4. Position moderate neck extension / shoulder roll under shoulder
ASSESS BREATHING:
If not breathing,

Tap foot
Turn newborn to side, RUB back
PPV Bag & Mask (30 s)
o Rate 40-60bpm bag two three, bag two three
o Position Neck moderately extended
o Mask Cover chin, nose & mouth, nose not pressed down!
o CHEST RISE!

ASSESS PULSE:
Palpate umbilicus for 6s (x10) for bpm

If >60bpm but <100bpm, PPV only

If <60 bpm, PPV + chest compressions (1 minute)
o Site:
Palpate subcostal margin out to in, to locate xiphisternum.
Find midpoint of xiphisternum and nipple line.
o Technique:
2 thumb tip of thumb
2 consecutive fingers 3rd & 4th finger, vertical, use other hand
to support back
Both fingers must touch, dont lift fingers from chest
o Coordination:
One, two, three, bag; one, two three, bag

o
o
o
o
o

Rate 40-60 bpm

Depth 1/3 of AP diameter
Position Neck moderately extended
Mask cover chin, nose & mouth, nose not pressed down
CHEST RISE!

ASSESS PULSE & BREATHING

If
If
If
If
If

still <60bpm, PPV + chest compression

>60bpm but <100bpm, PPV
>100bpm, slowly discontinue PPV
breathing, free flow O2
not breathing, PPV

Keep reassessing every 1 minute until >100bpm and breathing.

SPO2 with PRE-DUCTAL PULSE OXIMETRY to avoid hyperoxia

Site: Right hand preductal

Ref values:
o 1 min 60-70%
o 2 min 65-85%
o 3 min 70-90%
o 4min 75-90%
o 5 min 80-90%
o 10min 85-90%
Eg. If 7 min 88%, 2 min 62%, 3.5min 75% - normal wean off Supp O2
Eg. If 4min 75%, abnormal CONTINUE O2

PPV
A T-piece device, a self inflating bag, and a flow inflating bag are all acceptable
devices to ventilate newborn infants either via a face mask or endotracheal tube
(PPV) via face mask is initiated with 21 percent oxygen (room air) or blended
oxygen, and the pulse oximeter probe is applied to the right hand/wrist to monitor
heart rate and oxygen saturation
When the heart rate increases to more than 100 bpm, PPV may be discontinued if
there is effective respiratory effort. Oxygen is decreased and discontinued once the
infant's oxygen saturation meets the targeted levels.
Free-flow Oxygen can be administered via NP, face mask, etc.