Delivery Room Care and Neonatal Resuscitation
Resuscitation is a sequence of reversible steps
NRP emphasizes anticipation, teamwork, and rapid correction of ventilation. At birth, assess term gestation, tone, breathing, and heart rate. If the infant is vigorous, dry, warm, and place skin-to-skin; if not, begin initial steps. Positive-pressure ventilation is indicated for apnea, gasping, or heart rate below 100; use a self-inflating bag, T-piece, or blender-adjusted oxygen. Correct ventilation with MR SOPA (mask adjustment, reposition airway, suction, open mouth, pressure increase, alternative airway) before escalating. Chest compressions begin if heart rate remains below 60 after at least 30 seconds of effective ventilation, at a 3:1 compression-to-ventilation ratio. Epinephrine is given for persistent bradycardia despite effective ventilation and compressions.
Traps: using Apgar scores to drive resuscitation; routine intubation for meconium-stained fluid in a vigorous infant; delaying compressions while ventilation is inadequate; and forgetting that volume expansion is reserved for shock or blood loss. Oxygen should be titrated to preductal saturation targets, not 100%.
Worked example: a term infant with meconium-stained fluid is limp and apneic. The team places the infant under radiant heat, clears the mouth and nose, and starts PPV within the first minute. Heart rate rises to 120, so compressions are unnecessary.
Rule of thumb: “Ventilate first; compress only after effective ventilation; give epinephrine only after both.”