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Neonatal Resuscitation, 2020

The American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care nof the Neonate were updated in 2020. The following are a few notes form the guidelines:


Top 10 Take-Home Messages for Neonatal Life Support

  1. Newborn resuscitation requires anticipation and preparation by providers who train individually and as teams.
  2. Most newly born infants do not require immediate cord clamping or resuscitation and can be evaluated and monitored during skin-to-skin contact with their mothers after birth.
  3. Inflation and ventilation of the lungs are the priority in newly born infants who need support after birth.
  4. A rise in heart rate is the most important indicator of effective ventilation and response to resuscitative interventions.
  5. Pulse oximetry is used to guide oxygen therapy and meet oxygen saturation goals.
  6. Chest compressions are provided if there is a poor heart rate response to ventilation after appropriate ventilation corrective steps, which preferably include endotracheal intubation.
  7. The heart rate response to chest compressions and medications should be monitored electrocardiographically.
  8. If the response to chest compressions is poor, it may be reasonable to provide epinephrine, preferably via the intravenous route.
  9. Failure to respond to epinephrine in a newborn with history or examination consistent with blood loss may require volume expansion.
  10. If all these steps of resuscitation are effectively completed and there is no heart rate response by 20 minutes, redirection of care should be discussed with the team and family.

Additional Notes:

  • Ventilations: 40-60 breaths per minute
  • O2 Saturation: see chart above. Target saturation is 60-65% at 1 minute and increases up to 85-95% at 10 minutes
  • Heart Rate:
    • normal is >100 beats per minute,
    • 60-100 start assisted ventilation (Bag Mask)
    • <60 for 30 seconds, start chest compressions, intubate, IV epinephrine
  • Compressions: 90 compressions per minute with 3:1 ventilations (30 per minute), two thumb technique
  • Suction: Use bulb syringe. Little benefit from tracheal suction.
  • Access: Preferably an umbilical vein line. Use 5 french (approx 16 guage) line inserted 4-5 cm until blood returns.

Source:

Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Khalid Aziz, MBBS, MA, MEd(IT), Chair, Henry C. Lee, MD, Vice Chair, Marilyn B. Escobedo, MD, Amber V. Hoover, RN, MSN, Beena D. Kamath-Rayne, MD, MPH, Vishal S. Kapadia, MD, MSCS, David J. Magid, MD, MPH, Susan Niermeyer, MD, MPH, Georg M. Schmölzer, MD, PhD, Edgardo Szyld, MD, MSc, Gary M. Weiner, MD, Myra H. Wyckoff, MD, Nicole K. Yamada, MD, MS, Jeanette Zaichkin, RN, MN, NNP-BC

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