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Neonatal resuscitation
Medical expert of the article
Last reviewed: 04.07.2025
Approximately 10% of newborns require some degree of resuscitation during birth. The reasons for this are numerous, but most involve asphyxia or respiratory depression. The incidence increases significantly with birth weights less than 1500 g.
[ Surveys
An Apgar score of 0 to 2 points is assigned for each of the 5 parameters of the newborn's condition (appearance, pulse, reflexes, activity, breathing). The score depends on the physiological maturity, maternal treatment in the perinatal period, and the prevalence of cardiorespiratory and neurological disorders in the fetus. A score of 7 to 10 at the 5th minute is considered normal; 4 to 6 is moderately low, and 0 to 3 is low. A low Apgar score is not in itself a diagnostic criterion for perinatal asphyxia, but is associated with the risk of long-term neurological dysfunction. An unreasonably long (> 10 min) low Apgar score indicates an increased risk of death in the first year of life.
The earliest sign of asphyxia is acrocyanosis, followed by respiratory distress, decreased muscle tone, reflexes, and heart rate. Effective resuscitation initially results in an increase in heart rate, followed by improvement in reflex response, skin color, respiration, and muscle tone. Signs of fetal distress during labor, an Apgar score of 0 to 3 for more than 5 minutes, an umbilical arterial blood pH of less than 7, and a neonatal neurologic syndrome including hypotension, coma, seizures, and signs of multiple organ dysfunction are manifestations of perinatal asphyxia. The severity and prognosis of posthypoxic encephalopathy can be assessed using the Sarnat classification in combination with EEG, auditory and cortical evoked potentials.
Resuscitation
Initial management for all neonates includes mucus suctioning and tactile stimulation. Suctioning of the mouth, nares, and pharynx should be done immediately after birth, especially in neonates with meconium in the amniotic fluid, and then intermittently, avoiding deep suctioning of the oropharynx. Suctioning requires properly sized catheters and pressure limitation to 100 mmHg (136 cm H2O). Tactile stimulation (eg, patting the soles of the feet, stroking the back) may be necessary to establish spontaneous, regular breathing. Neonates in whom adequate breathing and heart rate have not been established require O2 administration, bag-mask ventilation, sometimes tracheal intubation, and, less commonly, cardiac massage.
The child is quickly wiped with a dry, warm diaper and placed under a radiant heat source in a supine position. The neck is supported in a mid-position with a rolled-up towel placed under the shoulders.
Oxygen therapy is administered at a rate of 10 L/min through an oxygen mask connected to a self-inflating or anesthetic bag; if a mask is not available, an oxygen tube placed near the face and delivering oxygen at a rate of 5 L/min can be used. If there is no spontaneous breathing or the heart rate is less than 100 beats per minute, assisted ventilation is used through a mask using an Ambu bag. The presence of bradycardia in a child with RDS is a sign of impending cardiac arrest; neonates tend to develop bradycardia with hypoxemia.