Newborn Basic Life Support

Select the images below to review resuscitation guidelines for a newborn.

Open the airway

Before the infant can breathe effectively the airway must be open. The best way to achieve this is to place the infant on their back with the head in the neutral position (i.e. with the neck neither flexed nor extended).

The infant’s head should be in a neutral position.

Check the airway for any obstructions.

Use the correct face mask

Ensure the mask is the right size - it should cover the nose and mouth but should not reach the eyes.

Apply the mask with pressure from the upper section, avoiding the rim to ensure seal against the face.

Chest compressions

Compress the lower third of the sternum
Place fingers just below an imaginary line joining the nipples
- If you are on your own - use two fingers
- If there are others - use the two thumb (two-handed) technique
Depress the lower sternum by at least 1/3 the depth of the chest
Don’t be afraid to push too hard
Release the pressure completely
Deliver three chest compressions to one rescue breath

Aim for 120 events/min (breath+compressions).

Postnatal

Once a newborn has been moved on to a ward or returned home, it is very rare for complications to develop. However, postnatal collapse is life threatening and it's essential to call for help early.

The chart below details basic life support for a neonate.

ABC principles apply.

Airway

Assessment

Is the airway patent and maintained?
Are there added noises?
Is there a see-saw movement of the chest and abdomen?

Management

Ensure the airway is patent and maintained
Simple airway manoeuvres (see image)
Consider suction, airway adjuncts, position of the patient
Oxygen via correct size face mask (see image)
Consider passing a nasogastric tube and aspirating stomach contents if infant has been previously fed

Breathing

Assessment

Observe:
- Rate and pattern
- Depth of respiration
- Symmetry of chest movement
- Use of accessory muscles
- Colour of patient
Where available, use pulse oximetry to guide oxygen use. Aim for sats up to 96%

Management

Position of patient
Oxygen via correct size face mask
Face mask ventilation if the baby is gasping or not breathing

Circulation

Assessment

Manual pulse and BP
Capillary refill time
Urine output
Fluid balance
Temperature - consider cooling

Management

Ensure central access via Umbilical Venous Catheter or UVC (IO/IV cannulation may be used as an alternative)
Take bloods
Blood cultures
Fluid bolus

Session Summary

Key Points

Once a newborn has been dried and wrapped, assess for breathing, heart rate and tone
Call for help early and continue to ask yourself - do I need help?
If a baby is gasping or not breathing, open the airway and give five inflation breaths using the correct size mask - it should cover the nose and mouth but should not reach the eyes
If the chest starts to move but the heart rate is still slow, start chest compressions with a ratio of three compressions to one inflation for 30 seconds
Drugs are rarely needed and only if there is no significant cardiac output, despite effective lung inflation and chest compressions. The outlook for most babies at this stage is poor
The use of the SBAR or the RSVP tool enables timely communication between individuals from different clinical backgrounds and hierarchies
Once a newborn has been moved on to a ward or returned home, it is rare for complications to develop, however, post-natal collapse is life threatening and it's essential to call for help early. ABC principles apply

Next Steps

Continue to the Resuscitation Newborn Level 2 eAssessment. This should be completed to demonstrate the required knowledge and understanding and to complete the training. Remember to also familiarise yourself with local procedures.

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