Chapter 2 Resuscitation

2.1 Delivery Room Preperation

NICU Role

When called to the delivery of an infant, the NICU staff is responsible for resuscitating the infant, performing the initial newborn exam, drawing labs if needed and determining the proper disposition for the infant (NICU vs. General Care Nursery).

Know your institute specific Type of Codes and which personnal is needed for each code.

Upon reaching the DR, ask following

  • Indication for code
  • Gestational Age
  • How many babies
  • presence/absence of meconium

When the baby is born there are three questions to be asked and answered:

  • Was the baby born at term?
  • Is the baby breathing or crying?
  • Is there good muscle tone?

Preparation

  • Warmer/Bed: turn up the heat on the warmer, prepare the blankets
  • Bag-mask: turn on the wall oxygen (8-10 liters per minute).
  • Prepare Neopuff and appropriate size mask
    • green = infant approximately > 32 weeks;
    • red = preterm infant approximately < 32 weeks).
  • Suction: turn on the wall suction (50-80 mmH2O) and connect the suction tubing
  • Meconium aspirator: if meconium is present, connect the meconium aspirator to the suction tubing
  • Intubation:
    • Choose laryngoscope blade
      • No-0 blade for preterm,
      • No-1 blade for term
    • Check light source.
    • Choose ETT size (see below).
    • Prepare the stylet, if needed, making sure the stylet tip does not protrude beyond the end of the ETT.
  • Other equipment: prepare blue bulb syringe, cord clamp and hat

Targeted Pre-ductal SpO2 after birth

Minutes Saturations
1 minute 60-65%
2 minutes 65-70%
3 minutes 70-75%
4 minutes 75-80%
5 minutes 80-85%
10 minutes 85-95%

ETT Size:

GA Weight ETT size
< 28 weeks < 1 kg 2.5
28 – 34 weeks 1-2 kg 3.0
34 – 38 weeks 2-3 kg 3.5
> 38 weeks > 3 kg 4.0

Insertion Depth: 6 + wt (kg) = cm at the lip