The primary objectives in pre-hospital resuscitation of the neonate include
(1) establishment of an airway and provide adequate respirations,
(2) maintenance of a heart rate (HR) > 60 bpm, and (3) treatment of hypoglycemia.
Maintain an open airway. Suction the mouth first, then the nose. If THICK meconium is present and the infant is depressed and/or minimally responsive, prepare for endotracheal intubation.
Dry the infant and keep warm.
a. Cover the head
b. Place heat packs (wrapped in towels) next to infant’s body
c. Prevent air drafts near infant
If respirations are depressed and/or infant not alert, provide physical stimulation.
Assess heart rate (HR) via palpation and cardiac monitoring.
a. If HR 60 – 80 and increasing, assist ventilations.
b. If HR < 60 and not increasing, assist ventilations and perform chest compressions.
i. Administer EPINEPHRINE 1:10,000 0.01 – 0.03 mg/kg IV/IO
ii. May give EPINEPHRINE 1:1,000 0.01 mg/kg via ET while vascular access is being established
Initiate IV access, if able. Do not attempt IO access in newborn UNLESS cardiac arrest present and need for drugs anticipated.
If HYPOGLYCEMIA is present, treat per Pediatric Diabetic Emergencies Protocol.
If respiratory or cardiac arrest present, go to Pediatric Cardiac Arrest Protocol.