Neonatal resuscitation is a high risk, low frequency emergency situation that occurs in approximately 10% of births (1). Preparation and training are essential because the need for advanced resuscitation is often unanticipated prior to delivery. For this reason, simulation training has become a central component of NRP certification and continuing education. The TABCS (temperature, airway, breathing and circulation and supplies) are essential components of all neonatal resuscitations. Continue reading to learn more about how to incorporate these into your neonatal resuscitation training program.
Preterm and term newborns who have poor muscle tone or are not breathing should be brought to a radiant warmer for resuscitation. This is essential because cold stress in poorly oxygenated infants can trigger anaerobic metabolism, tissue hypoxia and hypoglycemia. Skin sensors should be used to maintain the newborn’s temperature between 97.7°F-99.5°F (36.5°C-37.5°C) during initial resuscitation and transport to the neonatal unit. This is especially important for premature infants who are at greatest risk of heat loss.
Once the infant is placed in the radiant warmer, a diaper should be placed underneath the shoulders to open the airway. A sterile bulb syringe may be used to gently suction the nose and mouth. Aggressive suctioning of the posterior airway can cause laryngospasm, apnea and bradycardia. Endotracheal intubation with direct tracheal suctioning is indicated if the infant has gasping, retractions, and difficulty clearing the airway. The wall suction should be set so that pressures do not exceed 100 mm Hg. If desired, a size 1.0 laryngeal mask airway (LMA) may be used as an alternative to an endotracheal tube.
Positive-pressure ventilation should be started immediately for newborns who are gasping, apneic, or have a heart rate below 100 beats per minute. An infant BVM resuscitator with a manometer and release valve should be used so that pressure does not exceed 30-40 cm H2O during the first breaths. A pulse oximetry monitor should be placed around the palm or foot to guide oxygen therapy. Given the risk for harm from hyperoxia, ventilation may be started with 21-30% oxygen and titrated to keep the saturation around 90%. The infant’s heart rate should rapidly increase once assisted breaths are provided.
Auscultation with an infant stethoscope remains the preferred method for the initial assessment of the heart rate. However, continuous ECG monitoring is faster and more accurate than pulse oximetry to assess the infant’s response to resuscitative interventions. IV epinephrine is indicated if the infant’s heart rate remains below 60 beats per minute despite ventilation and chest compressions. Administration of epinephrine is an essential component of neonatal resuscitation because dosing errors are common. Normal saline 10 mL/kg IV over 5-10 minutes may be used for fluid expansion if the infant is hypovolemic.
Simulation with deliberate practice has become an essential component of neonatal resuscitation training. The wireless, high fidelity CAE Luna Infant Simulator replicates an infant from birth to 28 days after delivery with a target weight of 8 lbs. The CAE Maestro software includes five newborn care scenarios that comply with current assessment and resuscitation standards. The SimVS Hospital Plus Patient Monitor can be used with the Luna Simulator so that participants can see the effects of their interventions in real time. Educators can create a realistic care environment with the brand new SimLabSolutions 7013 Radiant Infant Warmer. It was designed for healthcare education but it includes all the same features that participants will use in the clinical setting.
High-fidelity infant simulators and virtual monitors allow educators to create realistic, accurate and engaging neonatal resuscitation scenarios. DiaMedical USA has all of the equipment and supplies that are needed for initial NRP.