Neonatal Care and Resuscitation
What this domain tests
Neonatal questions test the first minute of life: warmth, drying, stimulation, assessment of breathing and heart rate, and escalation to positive-pressure ventilation and chest compressions. The exam expects a precise sequence.
Core rules
- After birth, provide warmth, dry the baby, stimulate, position the head neutrally, and assess breathing and heart rate. Most newborns who are breathing and vigorous need only routine care.
- If the baby is apnoeic, gasping, or has a heart rate below 100 beats per minute, start positive-pressure ventilation. Use a self-inflating bag or T-piece with an appropriate mask and a rate of 40–60 breaths per minute.
- Start chest compressions if the heart rate remains below 60 beats per minute after 30 seconds of effective ventilation. Use a 3:1 compression-to-ventilation ratio: 90 compressions and 30 breaths per minute.
- Use oxygen guided by local protocols and pulse oximetry. Term babies usually start at 21% oxygen; preterm babies may start at 21–30%.
- Give epinephrine if the heart rate remains below 60 beats per minute despite effective ventilation and compressions.
- Prevent heat loss with a warm room, skin-to-skin contact, hats, and plastic wrapping for very preterm infants.
Worked example
A term newborn is apnoeic with a heart rate of 70 after drying and stimulation. Start positive-pressure ventilation for 30 seconds. Reassess: the heart rate is 50 and the chest is not moving. Reposition the head, check mask seal, suction if obstructed, and continue ventilation. Add chest compressions at 3:1. Reassess heart rate every 60 seconds.
Traps that cost marks
Do not suction routinely; suction only if the airway is obstructed. Do not use Apgar to decide on resuscitation. Do not start compressions before effective ventilation. Do not stop compressions until the heart rate is above 60. Avoid excessive oxygen in preterm infants.
Key points
- Dry, warm, stimulate, and assess breathing and heart rate.
- Positive-pressure ventilation is indicated for apnoea, gasping, or heart rate below 100.
- Chest compressions start when the heart rate is below 60 despite effective ventilation.
- The compression-to-ventilation ratio is 3:1.
- Epinephrine is used when the heart rate remains below 60 despite ventilation and compressions.
- Routine suctioning is not recommended.