Newborn Assessment and Neonatal Resuscitation
This domain tests immediate newborn care and the first minutes of resuscitation. You must know the sequence, heart-rate thresholds, drugs and doses, and be able to distinguish Apgar scoring from resuscitation decisions.
Core rules and concepts
- Dry, stimulate, warm and assess tone and breathing immediately. For term infants not needing resuscitation, delay cord clamping for 60 seconds.
- Apgar at 1 and 5 minutes: appearance, pulse, grimace, activity and respiration. It describes condition and response to resuscitation, not the resuscitation algorithm.
- Newborn resuscitation: initial steps for 30 seconds. If apnoeic or heart rate below 100 bpm, start positive pressure ventilation (PPV) with 21% oxygen at term. If heart rate remains below 60 bpm after 30 seconds of effective ventilation, start chest compressions at a 3:1 ratio with PPV.
- Epinephrine if heart rate remains below 60 bpm after compressions: 0.01–0.03 mg/kg IV or intraosseous. Consider intubation and vascular access.
- Preterm below 35 weeks: start with 21–30% oxygen using a blender; avoid hyperoxia.
- Vitamin K 1 mg intramuscularly at birth; newborn bloodspot at 5–8 days; hearing screening; assess feeding, jaundice, temperature and hypoglycaemia.
- Jaundice: measure bilirubin if jaundice is visible within 24 hours or feeding is poor; use treatment thresholds by age and gestation.
Worked example
A term baby is born through thick meconium, is floppy, not breathing and has a heart rate of 70 bpm. Reasoning: the heart rate is below 100 bpm, so the priority is effective PPV, not chest compressions. Dry and stimulate briefly, position, apply a mask and give PPV for 30 seconds, then reassess the heart rate. If it remains below 60 bpm, add compressions. Do not suction routinely.
Traps
- Using Apgar to decide whether to start resuscitation.
- Starting chest compressions before effective ventilation.
- Suctioning all meconium-stained babies.
- Giving 100% oxygen to a term baby at the start.
- Delaying ventilation to dry or weigh the baby.
Key points
- Dry, stimulate and warm; start PPV if apnoeic or heart rate below 100 bpm.
- Chest compressions only if heart rate is below 60 bpm after effective PPV.
- Compression-to-ventilation ratio is 3:1; epinephrine 0.01–0.03 mg/kg IV.
- Apgar at 1 and 5 minutes describes condition, not the resuscitation algorithm.
- Give vitamin K 1 mg intramuscularly; newborn bloodspot at 5–8 days.