- Annually, almost 1 million deaths worldwide are related to birth asphyxia. ∼10% of newborns require some assistance at birth and 1% of newborns require extensive resuscitation
- An APGAR score (Activity, Pulse, Grimace, Appearance, Respiration) is calculated for all infants at 1 and 5 min of life
- The APGAR score is a tool used to quantify an infant's clinical status. It should not be utilized to predict outcomes or guide resuscitation
- 5 categories with score of 0, 1, or 2 assessed at 1 and 5 min
- Do not wait to assign APGAR scores before starting resuscitation
- An APGAR score that remains a 0 after 10 min of resuscitation suggests that further resuscitation is unlikely to be successful and may be a useful tool in determining when to withdraw care
- The health care provider and parents of a high-risk newborn must discuss the appropriateness of resuscitative measures. This is ideally done prior to delivery:
- Newborns confirmed to be <23-wk gestation or 400 g
- Babies with confirmed trisomy 13 or 18
- A physician is not ethically or legally required to perform futile or potentially harmful interventions, or to withhold beneficial treatment at the request of the parents
Heart Rate (HR) Score 0 0 <100 bpm 1 >100 bpm 2 Respiration Score Absent 0 Slow, irregular 1 Good, crying 2 Muscle Tone Score Limp 0 Some flexion 1 Active motion 2 Reflex Irritability Score No response 0 Grimace 1 Cough, sneeze, cry 2 Color Score Blue or pale 0 Pink body, blue extremities 1 All pink 2
- Fetal–maternal gas exchange is facilitated by two right-to-left shunts:
- Ductus arteriosus: Deoxygenated blood flows from the pulmonary artery to the descending aorta, bypassing the carotid arteries
- Foramen ovale: Oxygenated blood flows from the placenta, through the fetal vasculature, into the right atria and is shunted through the foramen ovale to the left atria and aorta, bypassing the fetal lungs
- The first spontaneous respirations by the infant initiate a cascade of physiologic changes including fluid clearance from the alveoli, lung expansion, decrease in pulmonary vascular resistance, and closure of the right-to-left shunts
- Any problem with the respiratory effort, airway, or lung function portends a problematic transition to extrauterine life, leading to neonatal hypoxia and the need for resuscitation. Hypoxia may initially cause tachypnea followed by primary apnea
- Antepartum risk factors associated with the need for resuscitation include:
Maternal diabetes Pregnancy-induced or chronic hypertension Anemia Previous fetal or neonatal death Bleeding in second or third trimester Maternal infection Maternal cardiac, renal pulmonary, thyroid, or neurologic disease Polyhydramnios or oligohydramnios Premature rupture of membranes Post-term gestation Multiple gestation Size–dates discrepancy Drug therapy Maternal substance abuse Fetal malformation Diminished fetal activity No prenatal care Maternal age <16 or >35 yr
- Intrapartum risk factors associated with need for resuscitation include:
Emergency C-section Forceps or vacuum assist Breech or other abnormal presentation Premature labor Precipitous labor Chorioamnionitis Prolonged rupture of membranes Prolonged second stage of labor Fetal bradycardia Nonreassuring fetal heart tracing General anesthesia Uterine tetany Narcotics administered to mother within 4 hr of delivery Meconium-stained amniotic fluid Prolapsed cord Abruptio placenta Placenta previa
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Schaider, Jeffrey J., et al., editors. "Resuscitation, Neonate." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307096/all/Resuscitation_Neonate.
Resuscitation, Neonate. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307096/all/Resuscitation_Neonate. Accessed June 6, 2023.
Resuscitation, Neonate. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307096/all/Resuscitation_Neonate
Resuscitation, Neonate [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 June 06]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307096/all/Resuscitation_Neonate.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Resuscitation, Neonate ID - 307096 ED - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307096/all/Resuscitation_Neonate PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -