Neonatology

I. Newborn Resuscitation

A. Algorithm for Neonatal Resuscitation (Fig. 18.1)

  1. 1. Essential functional equipment: Radiant warmer, prewarmed blankets, hat, bag-mask/NeoPIP ventilator, appropriately sized laryngoscope, appropriately sized endotracheal tube (ETT) ± stylet, suction device and bulb syringe, emergency medications, and vascular access supplies
  2. 2. Meconium-stained fluids: Routine intrapartum oropharyngeal/nasopharyngeal suctioning and endotracheal intubation are not recommended for vigorous and nonvigorous infants.1
  3. 3. Cord clamping should be delayed for at least 30 to 60 seconds for vigorous term and preterm infants, given no maternal or fetal indications for immediate clamping. See eBox 18.1 for exclusions. Cord milking should NOT be used for infants less than 28 weeks of gestation given link with intraventricular hemorrhage. There is insufficient evidence to support or refute use of umbilical cord milking for infants born at 32 weeks of gestation or more, including term.2

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FIGURE 18.1
Overview of resuscitation in the delivery room. CPAP, Continuous positive airway pressure; HR, heart rate; IV, intravenous; PPV, positive pressure ventilations.

From American Academy of Pediatrics [AAP], American Heart Association. Textbook of Neonatal Resuscitation [NRP]. 8th ed. American Academy of Pediatrics; 2021.

B. Endotracheal Tube Size and Depth of Insertion (Table 18.1)

  1. 1. Quick estimations:
    1. a. ETT size: 2.5 mm for infants <30 weeks gestational age (wGA); 3.0 mm for 30 to 34 wGA; 3.5 mm for >35 wGA.
    2. b. ETT depth: Infant’s weight (kg) + 6 cm

C. Vascular Access (See Chapter 4 for Umbilical Venous/Artery Catheter Placement)

    • NOTE: During emergent placement, an umbilical venous catheter (UVC) may be inserted just far enough to obtain blood return; no measurement or verified placement is needed prior to emergent use.

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