Neonatal Circulation Assessment

Aka: Neonatal Circulation Assessment

1. See Also
   1. Newborn Resuscitation
   2. Neonatal Airway Assessment
   3. Neonatal Breathing Assessment
   4. Neonatal Perfusion Assessment
   5. Neonatal Distress Causes
2. Protocol
   1. Heart Rate over 100/min
      1. Proceed to Neonatal Perfusion Assessment
   2. Heart Rate under 100/min
      1. Positive Pressure Ventilation
         1. See Neonatal Breathing Assessment
         2. Continue Positive Pressure Ventilation until Heart Rate >100/min and adequate spontaneous respirations
         3. Re-evaluate Heart Rate every 30 seconds
      2. Heart Rate under 60/min after 30 seconds of PPV
         1. Positive Pressure Ventilation with 100% Oxygen
         2. Perform Chest Compressions
            1. Depress chest one third of AP chest diameter
         3. CPR Sequence
            1. Count: One and Two and Three and Breath
            2. Compression to breath ratio of 3:1
               1. Compress at rate of >90 beats per minute
               2. Breath at rate of 30 breaths per minute
         4. Reassess 45-60 seconds after starting compressions
            1. Epinephrine for persistent Heart Rate <60/min after 60 seconds of compressions (and 90 seconds of PPV)
         5. Additional measures for prolonged Resuscitation beyond 2-3 minutes
            1. Consider Orogastric Tube to decompress Stomach
            2. Consider Endotracheal Intubation
      3. Heart Rate under 100/min after 30 seconds of PPV
         1. Continue Positive Pressure Ventilation until Heart Rate >100/min and adequate spontaneous respirations
      4. Heart Rate over 100/min
         1. Go back to Neonatal Breathing Assessment
3. Management: Epinephrine
   1. Indication
      1. Persistent Heart Rate <60/min after 60 seconds of compressions (and 90 seconds of PPV)
   2. Dosing (use of 1:10,000 Epinephrine)
      1. Umbilical Venous Catheter: 0.01 to 0.03 mg/kg (0.1 to 0.3 ml/kg) of 1:10,000 Epinephrine
      2. Endotracheal Tube: 0.05 to 0.10 mg/kg (0.5 to 1 ml/kg) of 1:10,000 Epinephrine
      3. May repeat every 3-5 minutes for Heart Rate <60/min
4. Management: Pediatric Fluid Resuscitation
   1. Indication
      1. Suspected blood loss
   2. Crystalloid (NS or LR) 10 ml/kg over 5-10 minutes
      1. Umbilical Vein Catheter is most common site for delivery
      2. May repeat for a second dose
   3. Other fluids for Resuscitation
      1. Colloid Solution
      2. Packed Red Blood Cells
5. References
   1. Kattwinkel (2000) Neonatal Resuscitation, AAP-AHA
   2. Kattwinkel (2010) Neonatal Resuscitation, AAP-AHA
   3. Raghuveer (2011) Am Fam Physician 83(8): 911-8