| Drug Therapy | Epinephrine 0.01 0.03 mg/kg IV/IO; repeat every 3 5 minutes if heart rate is less than 60 bpm. Epinephrine 0.05 0.1 mg/kg ETT (not preferred route). Crystalloid 10 mL/kg IV/IO Sodium bicarbonate (4.2%) 1 2 mEq/kg IV/IO only for prolonged resuscitation and only if effective ventilation Dextrose (10%) 0.2 g/kg then 5 mL/kg/hr IV/IO if blood glucose level is less than 40 mg/dL Naloxone is not recommended |
| Compressions | Check pulse at brachial or femoral artery. Compression landmarks: Lower third of sternum between the nipples Method: Thumbencircling Depth: Approximately onethird anteroposterior chest diameter Allow complete chest recoil after each compression Compression rate: 100 120 per minute Compressiontoventilation ratio of 3:1 Coordinate compressions with ventilation Minimize interruptions in compressions to less than 10 seconds |
| Airway | Preterm newborns (<35 weeks) should receive low oxygen (FiO2 21% 30%). Suction after birth is only for babies with obvious obstruction or who require positive pressure ventilation. Suctioning during delivery has been shown to have no value. |
| Meconium | If meconium is present and the newborn is vigorous with good respiratory effort and muscle tone, he or she may stay with the mother, and bulb suctioning can be considered. If the infant is born through meconiumstained amniotic fluid and presents with poor muscle tone and inadequate breathing efforts, move him or her to a radiant warmer and follow typical initial evaluation steps. If meconium is present, routine intubation for tracheal suction is not recommended. If meconium is present and the infant is nonvigorous, current literature does not support routine intubation. |
| Ventilations | Rate of 40 60 breaths per minute Watch for visible chest rise. Administer positive endexpiratory pressure (PEEP), if available. |
| Consider Intubation | Ineffective or prolonged bagmask ventilation Cardiopulmonary resuscitation (CPR) is being performed Special circumstances such as congenital diaphragmatic hernia |
| Target Preductal SpO2 At Birth | 1 minute: 60% 65% 2 minutes: 65% 70% 3 minutes: 70% 75% 4 minutes: 75% 80% 5 minutes: 80% 85% 10 minutes: 85%95% |