General Approach to All Pediatric Patients

Newborn Resuscitation

Basic Life Support

  • Note gestational age, and if twin gestation is known
  • Assess for presence of meconium
  • Assess breathing or presence of crying
  • Assess muscle tone
  • Assess color
  • Provide warmth using blankets and cap
  • Spontaneously breathing, well-appearing infants do not require suctioning
    • For infants who have obvious obstruction to spontaneous breathing or who require positive-pressure ventilation, open airway and suction with bulb syringe
    • Suction mouth first, then nasopharynx
  • Dry, stimulate and reposition
  • Administer supplemental blow-by oxygen
  • Evaluate respirations, heart rate, and color
    • If apnea, or HR < 100, provide ventilations using BVM and room air initially
    • If HR remains < 60, begin chest compressions
  • Note APGAR scores at 1 and 5 minutes after birth and then sequentially every 5 minutes until vital signs have stabilized

Advanced Life Support

  • If the fluid contains meconium and the newborn has absent or depressed respirations, decreased muscle tone, or heart rate < 100 bpm:
    • Suction any visible meconium from the hypopharynx and airway
    • After suctioning, provide ventilations using BVM and 100% Oxygen
  • If apnea, or HR < 100, provide ventilations with 100% Oxygen
  • Target oxygen saturation after birth:
    • 1 min - 60-65%
    • 2 min - 65-70%
    • 3 min - 70-75%
    • 4 min - 75-80%
    • 5 min - 80-85%
    • 10 min - 85-95%
  • If HR remains < 60, administer chest compressions
  • Administer boluses of 0.9% NaCl at 10ml/kg
    • If no IV access obtained after 3 attempts, or within 90 sec., obtain IO access
  • Epinephrine 0.01 mg/kg IV of a 1:10,000 solution if no improvement
    • Repeat Epinephrine (same dose) every 3 to 5 minutes if no response
  • Naloxone (Narcan) 0.1 mg/kg, IV or IO if respiratory depression in a newborn of a mother who received narcotics within 4 hours of delivery
    • Repeat Naloxone (Narcan) dose as needed
  • Administer D10W at 2ml/kg; no need to check blood glucose prior to administration

Newborn Resuscitation Flowchart

APGAR Score

APGAR is a quick test performed at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score assesses how well the newborn is adapting to the new environment. The rating is based on a total score of 1 to 10, with 10 suggesting the healthiest infant. This test is a screening tool to help determine whether a newborn needs resuscitative efforts.

APGAR Score Chart

Abandoned Newborn

Florida statute 383.50 allows for new parents to anonymously leave a newborn at a fire station or a hospital. If this scenario is encountered, adhere to the following:

  • Assess and treat the newborn as per newborn/pediatric resuscitation protocols
  • Transport newborn to nearest emergency department
  • If possible record physical description of parent
  • Attempt to obtain information regarding prenatal care and pertinent family history
  • If any written information available, turn it over to the Emergency Department