Assessment/Initial Maneuvers

• Term, Tone, Crying?
• Warm/Dry/Stimulate
• Suction and position airway
• Place pre-ductal SpO2 (Right hand) and 3-lead cardiac monitor

Circulation/Breathing

• HR < 100 or apneic – Positive pressure ventilation at 30-60/min
• HR <60 – Compressions 3:1 ratio w/ ventilation (90:30/minute)
• Goal 80% SpO2 by 5 min

Airway

• Laryngoscope = term-#1; pre-term-#0; extreme pre-term-#00
• ETT size 
  •  4.0 uncuffed for term, progressively smaller from there
  • For pre-term can put decimal point into weeks to get size – e.g. 26 wks = 2.5 ET
• ETT depth – 3x tube size or wt in kg + 6
• LMA size
  • Reported down to 28 wks
  • size 1 up to 5 kg

Breathing

• BVM – 5-10 L off wall O2 should give FiO2 100%
• RR – 40-60/min
• PIP/PEEP: 20/5
• FiO2 – Start at 21% for term and 40% for pre-term

Additional Support

• If HR <60 at one minute despite PPV, start working on access (umbilical vein)
• If HR <60 at 90-120 seconds – epinephrine 0.01 mg/kg IV or 0.03 mg/kg via ETT – very cautious w/ dosing b/c NRP guidelines to dosing in ml/kg
• If HR < 60 after epi -> IVF 10 ml/kg over 5 min and assess for PTX

Oxygenation

 

 

 

 

 

 

 

DDx

• Obstruction – suction, prone position
• PTX – decompress w/ 18ga PIV cath or 10 fr chest tube
• Diaphragmatic hernia – intubate and NGT to decompress
• Right mainstem intubation – adjust for depth at 3x tube size
• Volume – 10 ml/kg NS bolus
• Hypoglycemia – 40 mg/dl as cutoff to treat – D10 2 ml/kg bolus then 4 ml/kg/hr
• Maternal opioids – naloxone 0.1 mg/kg
• Primary cardiac problem – PGE 0.1mcg/kg/min
• Hemorrhagic shock – Especially in cases of placental abruption
• Sepsis – send cultures and start Abx

 

Access

• UVC
  • Preflush the line
  • Advance until blood return