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Show Notes

Topic Overview:

• Discussing neonatal resuscitation in pre-hospital settings, focusing on field births and the associated challenges.

• Emphasis on the anxiety and critical nature of delivering and resuscitating a newborn in pre-hospital environments.

Identifying Trouble in Newborns:

• Indicators of a well infant: crying, good tone, initial blue color transitioning to pink within minutes.

• Concerning signs: prolonged blue color, floppy tone, lack of breathing.

Equipment and Techniques:

• Importance of using properly sized equipment for neonatal care.

• Discussion on substituting with available tools creatively when specific neonatal equipment is not accessible.

APGAR Scoring:

• APGAR scores are used at 1, 5, and sometimes 10 minutes post-birth.

• Components: heart rate, respirations, color, tone, and reflex irritability.

• APGAR scores of 9 are common; scores trending down indicate the need for further intervention.

Airway Management:

• Patience recommended before moving to advanced airways.

• Bag mask ventilation is crucial; intubation should be avoided if bagging is effective.

• Supraglottic airways (e.g., LMA or eye gel) are preferable in pre-hospital settings.

Resuscitation Steps:

• Effective ventilation is key; 40-60 breaths per minute for neonates.

• Avoid excessive oxygen; start with room air and adjust as needed.

• PEEP (Positive End-Expiratory Pressure) is essential in neonatal resuscitation.

Special Cases:

• Delayed Cord Clamping: Standard practice unless contraindicated by conditions like an abrupted placenta.

• Meconium-Stained Fluid: Current guidelines recommend against routine deep suctioning unless the baby is not vigorous.

Transport Considerations:

• Most newborns can be safely transported by ground; air transport may be needed for critically ill infants.

• Open abdominal wall defects and spina bifida require special handling, keeping defects moist and avoiding rupture.

Monitoring Tools:

• Use pulse oximetry to monitor oxygen saturation, starting at 65% and aiming for 90% within 10 minutes.

• Capnography primarily ensures proper airway placement; waveform presence is key.

Glucose Management:

• Newborn glucose target: ≥40 mg/dL; treat hypoglycemia with D10 bolus (2 mL/kg).

• Continuous glucose infusion for at-risk infants.

Final Thoughts:

• Importance of proper neonatal resuscitation training and preparedness.

• Keeping newborns warm, maintaining airway, and ensuring proper equipment use are critical.

The Protocols

From The Episode