Neonatal Resuscitation - Airway and Breathing
• Opened by placing the infants's head in a neutral position (b)
• Provide chin lift or jaw thrust if necessary (c)
• Suction any blood or secretions
• Consider placing a Guedel airway
Breathing — mask ventilation
• If not breathing adequately, start mask ventilation
• Mask is placed over mouth and nose (d) and connected to flow-controlled pressure-limited circuit (e.g. mechanical ventilator or Neopuff) or self-inflating bag (e)
• Head in neutral position
• Give 5 inflation breaths, inflation time 2-3 seconds at inspiratory pressure of 30 cm H2O in term infants to expand lungs
• If heart rate increases, but breathing does not start, continue with peak inspiratory pressure to achieve chest wall movement (15-25 cm H2O, 0.5 second inflation time) and rate of 30-40 breaths/min
• Begin ventilatory resuscitation in air to avoid excessive tissue oxygenation. If giving additional oxygen, use air/oxygen blender to titrate oxygen concentration with oxygen saturation on pulse oximeter. (Acceptable pre-ductal saturations - 2 min 60%; 3 min 70%; 4 min 80%; 5 min 85%; 10 min 90%.)
• Reassess every 30 seconds. If heart rate not responding, check mask position, neck position, is jaw thrust needed, is circuit all right, ensure adequate chest movement. Consider using two-person airway control (f). Call for help
• Intubation and mechanical ventilation (g) are indicated if: mask ventilation is ineffective, tracheal suction needed to clear an obstructed airway, congenital upper airway abnormality, extreme prematurity-for giving surfactant.
• Limit intubation attempts to 20-30 seconds.
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