Neonatal Resuscitation and Care of the At-Risk Newborn
Neonatal Resuscitation and Care of the At-Risk Newborn
This domain tests the first minute of life, ventilation, chest compressions, and ongoing care of preterm, low-birth-weight, infected, or jaundiced babies. The exam expects the current Helping Babies Breathe/Neonatal Resuscitation Program sequence, not APGAR-based resuscitation.
Core rules
- Initial steps: warm, dry, stimulate, position the head, clear the airway only if needed, and assess breathing and heart rate.
- If apnoeic or gasping, or heart rate <100/min, start positive pressure ventilation at 40–60 breaths/min with a self-inflating bag and mask.
- If heart rate remains <60/min after 30 seconds of effective ventilation, start compressions at 3:1 with 100% oxygen and continue ventilation.
- Epinephrine 0.01–0.03 mg/kg IV/IO if heart rate remains <60/min despite effective ventilation and compressions; consider volume expansion if shock.
- At-risk newborn care: temperature control, early breastfeeding or expressed milk, kangaroo mother care for stable low-birth-weight babies, glucose monitoring, and infection prevention.
Worked example
A term baby is apnoeic with heart rate 70/min at 30 seconds. Reasoning: start PPV immediately; do not wait for the 5-minute APGAR. Reassess after 30 seconds of effective ventilation; if the heart rate is still <60, add compressions. Suction only if the airway is obstructed.
Traps
Routine suctioning of meconium; using APGAR to decide resuscitation; prolonged stimulation before ventilation; overheating or cooling the preterm baby; and failing to check heart rate.