What are the guidelines for resuscitation of neonatal asphyxia?

When hearing the words “Neonatal Asphyxia Resuscitation Guidelines”, many parents will feel that it is an exaggeration. How could the baby suffocate when he is so well protected? But it is better to be safe than sorry. Make all preparations so that you won't be confused and don't know what to do in case of such a situation. So moms and dads, for your babies to grow up healthily and safely, let’s learn the guidelines for neonatal asphyxia resuscitation together.

1. Keep warm: Place the newborn on a radiant warming table or take appropriate warming measures according to local conditions, such as wrapping the newborn in a preheated blanket to reduce heat loss. For very low birth weight infants (VLBWI) weighing less than 1500g, some medical units can place the torso and limbs below the head in a clean plastic bag, or cover them with plastic film and place them on a radiant warming table. After positioning them, continue with other steps of initial resuscitation. Also avoid high temperatures as they can cause respiratory depression.

2. Body position: Place the newborn's head in a slightly supine position (nasal breathing position).

3. Suction: Before shoulder delivery, the midwife will manually squeeze out the secretions from the newborn's mouth, pharynx, and nose. After delivery, use a suction bulb or straw (12F or 14F) to clean the secretions, first from the oropharynx and then from the nasal cavity. Oversuction may cause laryngospasm and vagal bradycardia and delay spontaneous respiration.

4. Drying: Dry your entire body quickly and remove the wet towel.

5. Stimulation: Pat or flick the soles of the newborn's feet or rub the back twice with your fingers to induce spontaneous breathing. If these efforts are ineffective, it indicates that the newborn is in secondary apnea and requires positive pressure ventilation.

Recommendations on oxygen use: It is recommended that medical institutions at or above the county level install air-oxygen mixers and pulse oximeters in delivery rooms. Whether for full-term or premature infants, positive pressure ventilation should be performed under the monitoring and guidance of an oxygen saturation meter. Full-term infants can be resuscitated with air, and premature infants can be given 30% to 40% oxygen initially. An air-oxygen mixer can be used to adjust the oxygen concentration according to the oxygen saturation so that the oxygen saturation reaches the target value. If there is temporarily no air-oxygen mixer, positive pressure ventilation can be performed by removing the oxygen storage bag (oxygen concentration is 40%) and using an automatic inflatable air bag connected to an oxygen source. If the heart rate does not increase or the oxygen saturation does not increase satisfactorily after 90 seconds of effective ventilation, consideration should be given to increasing the oxygen concentration to 100%.

The pulse oximeter sensor should be placed in a preductal location (i.e., right upper limb, usually the mid-surface of the wrist or palm). Connecting the sensor to the baby before connecting it to the instrument will help to obtain the signal most quickly.

3. Positive pressure ventilation

The key to successful neonatal resuscitation is to establish adequate positive pressure ventilation.

1. Indications:

⑴ Apnea or gasping breathing.

⑵Heart rate 100 beats/min.

2. Bag-Valve-Mask Positive Pressure Ventilation

⑴ The ventilation pressure needs to be 20-25cm H2O (1cm H2O=0.098kPa). For a few severely ill newborns, 30-40cm H2O can be used 2-3 times, and then maintained at 20cm H2O.

⑵ Ventilation frequency 40 to 60 times/min (30 times/min during chest compressions).

⑶ Effective positive pressure ventilation should show a rapid increase in heart rate, which should be evaluated by heart rate, chest rise and fall, breath sounds and oxygen saturation.

⑷If positive pressure ventilation cannot achieve effective ventilation, it is necessary to check the airtightness between the mask and the face, whether there is airway obstruction (the head position can be adjusted, secretions can be cleared, and the newborn's mouth can be opened) or whether the air bag is leaking. The mask size should fit snugly over the mouth and nose but not cover the eyes or extend beyond the chin.

⑸ After 30 seconds of adequate positive pressure ventilation, if there is spontaneous breathing and the heart rate is ≥100 times/min, positive pressure ventilation can be gradually reduced and stopped. If spontaneous breathing is not sufficient or the heart rate is <100 beats/min, positive pressure ventilation should be continued using a bag-mask or endotracheal tube, and the ventilation operation should be checked and corrected. If the heart rate is <60 beats/min, intubate and initiate positive pressure ventilation and chest compressions.

In fact, it is not difficult to find that the suffocation mentioned in the Neonatal Asphyxia Resuscitation Guide is generally caused by carelessness. I think as long as parents pay more attention and be careful, the babies will be able to grow up healthy and happy. Prepare a resuscitation air bag at home and master the important things. Even if there are ten thousand, there will be the Neonatal Asphyxia Resuscitation Guide to protect us.