Newborn Resuscitation

During pregnancy the baby is dependent on the umbilical cord and placenta for oxygen delivery. 10% of newborns require some form of assistance to start breathing on their own and 1% requires extensive medical intervention known as neonatal resuscitation.

Neonatal resuscitation refers to emergency intervention techniques employed immediately after childbirth to assist babies who are not able to breathe independently after birth. If a newborn cannot begin breathing independently right away they are at risk of birth asphyxia which can cause serious brain injury and even death.

When abnormal breathing is observed after delivery, doctors (neonatologists/pediatricians) and neonatal nurses will have a very short window of time to intervene to avoid harm to the baby. Anticipating the potential need for neonatal resuscitation is often critical. The leading risk factor for newborn respiratory problems is prematurity. Another common cause of the need for neonatal resuscitation is birth injury from inadequate oxygen to the unborn baby during the labor and delivery process.

Risk factors and Symptoms of Neonatal Resuscitation:

• Maternal hypertension or cardiovascular disease
• Multiples (twins)
• Maternal drug/alcohol usage
• Trauma during birth
• Maternal age over 40
• Fetal macrosomia
• Meconium stained amniotic fluid
• Maternal infection
• Placental abruption

Neonatal Guidelines
Anticipation and Preparation: Newborn resuscitation depends heavily on proper planning and readiness of the team. Effective team behaviors, such as anticipation, communication, briefing, equipment checks, and assignment of roles, result in improved team performance and neonatal outcome.

The obstetrician or maternal fetal medicine doctors and the labor and delivery nurses are required to arrange a team to be present if there are signs that neonatal breathing assistance or neonatal resuscitation may be required. The hospital should then respond by sending a team to the delivery room.

This team may consist of neonatal nurses and/or doctors that will be either a neonatologist or pediatrician, depending upon the size and sophistication of the hospital. If a neonatal team is not requested, or is not assembled prior to delivery, then valuable minutes may be lost while the baby is not breathing.

Even if a team is not present at the time of delivery, the labor and delivery nurses and obstetrician delivering the baby must urgently call a team if a baby is unexpectantly born without breathing or not breathing properly. Every minute counts when a baby is not breathing!

Positive-pressure ventilation and Oxygen therapy (PPV): PPV remains the primary method for providing support for newborns that are apneic, bradycardic, or demonstrate inadequate respiratory effort. Pulse oximetry is used to guide oxygen therapy and meet oxygen saturation goals. This can include the intubation of the baby. A timely intubation will save a baby that is not breathing from any further damage. With proper oxygen therapy, a rise in heart rate is the most important indicator of effective ventilation and response to resuscitative interventions.

Chest compressions: If the heart rate remains less than 60/min despite 30 seconds of adequate PPV, chest compressions should be provided. The suggested ratio is 3 chest compressions synchronized to 1 inflation (with 30 inflations per minute and 90 compressions per minute) using the 2 thumb–encircling hands technique for chest compressions.

Vascular access: When vascular access is required in the newly born, the umbilical venous route is preferred. When intravenous access is not feasible, the intraosseous route may be considered.

Medications: If the response to chest compressions is poor, it may be reasonable to provide epinephrine, preferably via the intravenous route. This can help restart a baby’s heart and must be done timely!

Volume expansion: Failure to respond to epinephrine in a newborn with history or examination consistent with blood loss may require volume expansion.

Knowing the limitations: Doctors and nurses who provide neonatal resuscitation are faced with many challenges with respect to the knowledge, skills, and behaviors needed to perform effectively. These medical providers must be adequately trained on neonatal resuscitation methods and interventions. Neonatal resuscitation will always benefit from ongoing booster training, briefing, and debriefing.

Slow or improper performance of these procedures, and failure to perform procedures when indicated, can critically deprive adequate oxygen and blood flow to the baby. There are very specific guidelines published for medical professionals regarding what should be done in situations requiring neonatal resuscitation. Failure to follow acceptable standards and guidelines relating to neonatal resuscitation is medical negligence or medical malpractice.

Deprivation of oxygen and blood can lead to disability and permanent brain injuries, including hypoxic-ischemic encephalopathy (HIE), cerebral palsy, periventricular leukomalacia (PVL), and brain bleeds. The type and severity of the brain damage depend on many factors, including how long the baby was deprived of adequate blood flow and oxygen.

The Texas Birth Injury Attorneys at Miller Weisbrod understand the significant impact a birth injury will have not only on your child's life, but also your own. As experienced Birth Injury Lawyers, we fight hard for answers and justice if a delivery room error or doctor's negligence caused your child's birth injury.

If your child suffered a serious injury or lifetime disability due to a mistake before, during or after delivery, a lawsuit may be the best way to find out once and for all what happened and who should be held responsible. Contact us today to schedule a free consultation with an experienced birth injury lawyer. We encourage you to call our offices today at 214.987.0005 or toll free at 888.987.0005. You may also contact us by filling out the form on this page for answers to your important questions or to schedule an appointment.