Ep142 Neonatal Resuscitation – Airway, Temperature Control, Central Access, Hemodynamics, Glucose Control and Transport

There is something indescribable that happens when the overhead speaker crackles overhead with “Code Pink”. The stakes are high, and every person in the building collectively holds their breath. It’s in the air. All the more reason to know neonatal resuscitation better than the back of your hand. This is not an easy task. We’re talking about – hopefully - once-in-a-career events that require expertise, precision, and outstanding team dynamics. Resuscitation of the sick newborn is a HALO situation – High Acuity Low Opportunity for most of us. But there are few things in medicine more worthwhile knowing. Now, just to get things in perspective, thankfully about 90% of births are uncomplicated requiring just a quick overall assessment, a clamp and cut of the cord and placing the baby on mom’s chest to keep them warm. Of the remaining 10% - almost all of them just require just a bit of help – some stimulation and a bit of oxygen – easy stuff. But, of the births we manage in the ED a small percentage will require advanced resuscitation. Dr. Hilary Whyte, Dr. Jabeen Fayyaz and Dr. Emily MacNeil guide us through the AHA neonatal resuscitation algorithm box by box and highlight key strategies, techniques and equipment, and also some major pitfalls in early resuscitation... Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Lorraine Lau & Winny Li, edited by Anton Helman May, 2020 Infographic by Sarah Foohey Cite this podcast as: Helman, A. Whyte, H. Fayyaz, J. MacNeil, E. Episode 142 - Neonatal Resuscitation. Emergency Medicine Cases. May, 2020. https://emergencymedicinecases.com/neonatal-resuscitation. Accessed [date] General approach to neonatal resuscitation * ABC rather than CAB as recruitment of the lungs using positive pressure support, oxygenation and ventilation takes precedence over chest compressions * Goals of resuscitation: “warm, pink and sweet” * Prepare yourself, your team and your gear Preparation * Yourself: box breathing, positive self-talk, visualization, tell the mother that “we’ve got this” * Your team: call on RT, anesthesia, pediatrics, team debrief * Your gear: a warmer and a box of NRP equipment prepared in advance in the ED NRP Gear * ETT 3 sizes * Miller blades 0 and 1 * Video laryngoscope * Supraglottic airway * Oxygen masks * BVM * Clamp and scissors for cord * Towel for drying * Plastic bag / Ziploc bag * UVC catheter kit * IO kit Delayed cord clamping Consider delayed cord clamping in all vigorous neonates with good tone. Delaying clamping and cutting of the umbilical cord (60-90 seconds after birth) improves blood transfusion from the placenta to neonate with benefits such as decreasing the rate of intraventricular hemorrhage and necrotizing enterocolitis in preterm infants. While an increased rate of jaundice has been associated with delayed cord clamping, there are rarely any significant clinical sequelae. AHA Neonatal Resuscitation Algorithm BOX 1 Term? Good tone? Breathing or crying? If "Yes" (the neonate is term, has good tone and is breathing or crying) position airway, dry with towels, place infant on mother's chest. If "No" (the neonate is not term, does not have good tone or not breathing or crying) priorities are to warm the infant (see below), position the airway and stimulate. *Routine suctioning of secretions or meconium is no longer recommend unless overt airway obstruction is present Temperature management in the neonate: warming options and goals