Newborn Emergencies and Neonatal Resuscitation
This domain tests the first minute of newborn life and the common emergencies that follow.
Core rules
- Dry, warm, stimulate and position the head neutral. Suction only if the airway is visibly obstructed.
- Assess breathing and heart rate. If apnoeic or gasping, start bag-mask ventilation with room air at 40–60 breaths per minute for 60 seconds.
- If the heart rate is below 60 after effective ventilation, start chest compressions at a 3:1 ratio (90 compressions to 30 breaths) and reassess.
- Give epinephrine if the heart rate remains below 60 after 60 seconds of compressions with ventilation.
- Prevent hypothermia and hypoglycaemia; start kangaroo mother care for stable preterm or low-birth-weight babies.
Worked example
A term baby is not crying. After drying and stimulation the heart rate is 80 and breathing is absent. Reasoning: this is primary apnoea, so ventilation is the priority. Give positive-pressure ventilation for 60 seconds, then reassess. If the heart rate is 50, begin compressions and continue ventilation. Do not suction the mouth and nose routinely; that delays the first breath.
Traps
- Starting compressions before effective ventilation.
- Using 100% oxygen routinely instead of room air.
- Overheating the baby with a hot water bottle.
- Forgetting to check the heart rate after each intervention.