Resuscitation, Neonate

Resuscitation, Neonate is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Annually, almost 1 million deaths worldwide are related to birth asphyxia.
  • 10% of newborns require some assistance at birth.
  • 1% of newborns require extensive resuscitation.
  • Consider NOT initiating resuscitation if:
    • Newborns confirmed to be <23-wk gestation or 400 g
    • Anencephaly
    • Babies with confirmed trisomy 13 or 18
    • Ideally, discuss with family and health care team prior to delivery.
  • Activity, pulse, grimace, appearance, respiration (APGAR) scores do not guide resuscitation:
    • Do not wait to assign APGAR scores before starting resuscitation.
    • APGAR scores should NOT guide resuscitative efforts. It is a measure of an infant's status and response to resuscitation.
    • APGAR score: 5 categories with score of 0, 1, or 2 in each at 1 and 5 min
  • Heart rate (HR): 0 = absent; 1 = <100 bpm; 2 = >100 bpm
  • Respirations: 0 = absent; 1 = slow, irregular; 2 = good, crying
  • Muscle tone: 0 = limp; 1 = some flexion; 2 = active motion
  • Reflex irritability: 0 = no response; 1 = grimace; 2 = cough, sneeze, cry
  • Color: 0 = blue or pale; 1 = pink body and blue extremities; 2 = all pink

Etiology

  • Newborn's transition from dependence on the placenta to dependence on the lungs for oxygen.
  • Hypoxia initially causes tachypnea followed by primary apnea.
  • Stimulation may cause resumption of breathing during primary apnea.
  • Continued hypoxia leads to secondary apnea.
  • Secondary apnea requires assisted ventilation.
  • Antepartum risk factors associated with need for resuscitation include:
    • Maternal diabetes
    • Pregnancy-induced hypertension
    • Chronic hypertension
    • Anemia
    • Previous fetal or neonatal death
    • Bleeding in 2nd or 3rd trimester
    • Maternal infection
    • Maternal cardiac, renal pulmonary, thyroid or neurologic disease
    • Polyhydramnios
    • 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 yr 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 2nd stage of labor
    • Fetal bradycardia
    • Nonreassuring fetal heart tracing
    • General anesthesia
    • Uterine tetany
  • Narcotics administered to mother within 4 hr:
    • Meconium-stained amniotic fluid
    • Prolapsed cord
    • Abruptio placenta
    • Placenta previa

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Citation

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TY - ELEC T1 - Resuscitation, Neonate ID - 307096 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307096/all/Resuscitation__Neonate ER -