II. Protocol
- Measure Heart Rate with palpation of Umbilicus or on chest auscultation
-
Heart Rate over 100/min
- Proceed to Neonatal Perfusion Assessment
-
Heart Rate under 100/min
- Positive Pressure Ventilation
- See Neonatal Breathing Assessment
- Continue Positive Pressure Ventilation until Heart Rate >100/min and adequate spontaneous respirations
- Re-evaluate Heart Rate every 30 seconds
- Heart Rate under 60/min after 30 seconds of PPV
- Positive Pressure Ventilation with 100% Oxygen
- Perform Chest Compressions
- Depress chest one third of AP chest diameter
- CPR Sequence
- Count: One and Two and Three and Breath
- Compression to breath ratio of 3:1 (if cardiac etiology, 15:2 compressions to breaths)
- Compress at rate of >90 beats per minute
- Breath at rate of 30 breaths per minute
- Available staff should work toward Intravenous Access
- Umbilical Vein Catheter or
- Peripheral IV
- Reassess 45-60 seconds after starting compressions
- Epinephrine for persistent Heart Rate <60/min after 60 seconds of compressions (and 90 seconds of PPV)
- Additional measures for prolonged Resuscitation beyond 2-3 minutes
- Consider Orogastric Tube to decompress Stomach
- Consider Endotracheal Intubation
- Heart Rate under 100/min after 30 seconds of PPV
- Continue Positive Pressure Ventilation until Heart Rate >100/min and adequate spontaneous respirations
- Heart Rate over 100/min
- Go back to Neonatal Breathing Assessment
- Positive Pressure Ventilation
III. Management: Epinephrine
- Indication
- Persistent Heart Rate <60/min after 60 seconds of compressions (and 90 seconds of PPV)
- Dosing (use of 1:10,000 Epinephrine)
- May repeat every 3-5 minutes for Heart Rate <60/min
- IV or Umbilical Venous Catheter (UVC) - preferred routes
- Dose: 0.01 to 0.03 mg/kg (0.1 to 0.3 ml/kg) of 1:10,000 Epinephrine
- Consider intrasseous line if unable to obtain UVC or IV Line
- Endotracheal Tube
- Dose: 0.10 mg/kg (1 ml/kg) of 1:10,000 Epinephrine
IV. Management: Pediatric Fluid Resuscitation
- Precautions: Minimize blood loss in newborns
- Newborn Blood Volume: 85 ml/kg
- Newborn weighing 4 kg has only 340 ml total Blood Volume
- Every 34 ml (slightly more than 2 Tbs or 1 oz) is 10% of total Blood Volume
- Indication
- Suspected blood loss
- Crystalloid (NS or LR) 10 ml/kg over 5-10 minutes
- Umbilical Vein Catheter is most common site for delivery
- May repeat for a second dose
- Other fluids for Resuscitation
V. References
- Bhalla (2014) Crit Dec Emerg Med 28(1): 2-11
- Kattwinkel (2000) Neonatal Resuscitation, AAP-AHA
- Kattwinkel (2010) Neonatal Resuscitation, AAP-AHA
- Raghuveer (2011) Am Fam Physician 83(8): 911-8 [PubMed]