Neonatal Care

Inclusion Criteria: Term and pre-term newborn patients who fail to respond to initial stimulation and are in need of resuscitation efforts. This guideline also applies to all newborns and infants in the first few weeks of life.

          Basic Level

1. Within the first thirty seconds
         a.  Provide warmth (drying skin, increasing ambient temperature, cover with blanket)
         b.  Position the baby to facilitate drainage of airway secretions.
         c.  Suction fluid and secretions that are present.
                   i.  If meconium staining is present AND the newborn is not vigorous (weak or absent respiratory efforts, weak or absent muscle tone, heart rate less than 100 beats per minute), perform deep tracheal suctioning before taking other resuscitative steps.
         d.  Stimulate breathing (slapping or flicking the soles of the baby’s feet or rubbing the baby’s back).
   
   
2. Assess respirations.
         a.  If the respirations are inadequate or gasping is present, assist ventilation at a rate of 40 to 60 breaths per minute using a BVM with 100% oxygen.
         b.  If the respirations are shallow or slow, attempt a 1 minute period of stimulation while administering 100% oxygen via blow-by. If respirations do not increase, assist ventilation at a rate of 40 to 60 breaths per minute using a BVM with 100% oxygen.
   
   
3. Assess heart rate
         a.  If the heart rate remains less than 60 after respiratory management, begin chest compressions.
                   i.  Utilize 2 thumb-encircling hands technique
                   ii. Compression-to-ventilation ratio of 3:1 in neonatal resuscitation
         b.  If the heart rate is between 60-100 beats per minute, assist ventilation using a BVM with 100% oxygen.
   
   
4. Assess color
         a.  Peripheral cyanosis (acrocyanosis) does not require oxygen administration as this condition common during the first few minutes of life and does not indicate hypoxemia.
         b.  If central cyanosis is present in a newborn with spontaneous respirations and an adequate heart rate, administer 100% oxygen while attempting to determine the cause of the cyanosis.
   
   
5. Calculate APGAR score at 1 and 5 minutes postpartum.
   
   
6. Once advanced level care arrives on scene, give report and transfer care.
   
   
   Advanced Level
   
   
7. Notify the receiving hospital or contact BioTel as early as possible for destination recommendation and early receiving hospital notification.
   
   
8. Apply ECG and monitor heart rate continuously until arrival at the hospital.
   
   
9. If the patient is not responding to CPR, obtain IV or IO access with normal saline.
         a.  If hypoglycemic (BGA less than 100 mg/dL), administer dextrose 10% (5 mL/kg IVP or IO).
         b.  For pulse rates less than 60 bpm while CPR is in progress, administer 1:10,000 Epinephrine IVP/IO 0.01 mg/kg every 3 minutes.
         c.  Medics who suspect narcotic toxicity should administer naloxone 0.1 mg/kg via IN, IVP, or IO. Monitor for response. (Administration of naloxone is not recommended as part of initial resuscitative efforts for newborns with respiratory depression. Avoid naloxone administration in babies whose mothers are suspected of having had long term exposure to opiods.)
   
   
10. Transport as soon as possible.
    
    
11. For additional patient care considerations not covered under standing orders, consult BioTel.
    
    
    
    *APGAR Score

    Sign	0 Points	1 Point	2 Points
    Appearance (skin color)	Blue, pale	Body Pink, extremities blue	Completely pink
    Pulse rate (heart rate)	absent	less than 100 per minute	greater than 100 per minute
    Grimace (irritability)	No response	Grimaces	Cough, sneeze, cry
    Activity (muscle tone)	Limp	Some flexion	Active motion
    Respirations (respiratory effort)	Absent	Slow, irregular	Good, crying

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