Neonatal Resuscitation
How Newborn CPR Differs from Adult CPR
Unexpected or unplanned birth is most likely to occur prematurely with a baby at risk for low birth weight, hypothermia, hypoglycemia, and lack of oxygen. Other babies that come quickly before help can arrive are generally healthy, but problems can and do occur. Even though many people are trained in cardiopulmonary resuscitation, or CPR, they may not realize that newborns have different needs.
Adults May Only Need Compressions
The American Heart Association recently issued guidelines that effective chest compressions are far more important than ventilations for adult victims of heart attacks. This is because adult lungs have oxygen in reserve that, if accessed by the blood, can allow the brain and other organs to survive.
Newborns Primarily Need Ventilation
In Resuscitation at Birth, the textbook of the Resuscitation Council (UK), it states that "A baby who is breathing regularly, with a fast heart rate, who is centrally pink and who has good tone needs no further intervention and should be given to the mother."
Suction devices are not necessary to remove mucus from the newborn nose and throat. The lungs of the rescuer can remove such secretions or they can be allowed to drain naturally by tipping the baby's face down and holding the baby's body aloft on one arm. Vigorous babies can clear their own airways.
Babies are able to tolerate oxygen deprivation during contractions that squeeze them through the birth canal. Think of holding the breath for 50 to 75 seconds at a time to get an idea of a newborn's experience. A few babies will need help to establish normal breathing after delivery.
Before their first breaths, babies' lungs contain fluid. It takes effort to expand the lungs and force the fluid into the bloodstream. The heartbeat speeds up in response to ventilation. Babies that are unconscious or gasping cannot make this effort.
If the cord is still attached to the baby and the placenta has not delivered, do not cut the cord! The mother's contractions will continue pumping oxygenated blood to the baby until the placenta delivers, buying time for baby to come around. Keep the newborn dry and warm by placing him skin-to-skin with the mother's body, which is the best heater. It is also effective to cover the baby's body in clear plastic wrap.
Mouth to Mouth Can Help
When it is necessary to help the baby breathe, move the infant to a firm surface next to the mother. Placing a folded hand towel under the newborn's shoulders usually tips the baby's head back (sniffing position) so the airway is open. To perform mouth to mouth ventilation, cover the mouth and nose, or pinch the nose and cover the mouth, or close the mouth and cover the nose--a good seal is the important thing.
The first breaths should be slow and firm, and will meet resistance of fluid in the lungs. Think of inflating a new balloon. It takes as many as five long, slow, firm breaths to expand it initially. The baby's chest may not rise during inflation breaths. Subsequent breaths do not require as much force and they will cause chest movement. Between breaths, move away from the baby's face to allow the air to exit.
Chest Compression is Pointless Without Oxygenation
According to Resuscitation at Birth, "The airway may be blocked because the head is either too flexed or too extended or because the tongue has fallen back. These...are much more likely to be the cause of an airway problem than any...obstruction from blood, mucus, vernix or meconium." In other words, it is positioning, not lack of suctioning the baby's mouth and nose, that results in inadequate manual ventilation. Reposition the head and try giving breaths again.
Start Chest Compressions
Once the lungs have been ventilated, as evidenced by good chest movement, and the baby's heart rate is still slow and not rising, chest compressions are the next step. The goal of chest compressions in a newborn is to move a few teaspoons of oxygenated blood a few inches, from the heart to the lungs. With two fingers on the sternum below the nipple line (one rescuer), or using both thumbs with the hands encircling the baby's body (two rescuers), press and release the breastbone to a depth of about one inch. Ventilations must continue; the suggested ratio is three compressions per one breath. Slow down if necessary, don't rush the breath. It is vital to ventilate effectively.
The newborn is physiologically well-adapted to lack of oxygen at birth. When pushed beyond normal limits, babies require a little help to inflate their lungs, and rarely need chest compressions to move tiny amounts of blood a short distance.
References:
Resuscitation Council (UK), Resuscitation at Birth, London, 2001
Practicing Newborn CPR
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