Figure 58-2 New Guidelines and Algorithm for Neonatal Resuscitation. CPAP, Continuous positive airway pressure; PPV, positive-pressure ventilation. (From Kattwinkel J, Perlman JM, Aziz K, et al: Special Report—Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Pediatrics 126(5):e1400–e1413, 2010. Erratum in Neoreviews 128(1):176,
Consider: 2011. doi: 10.1542/peds.2011-1260.)
If the infant does not revive, an endotracheal tube should be placed, attached to the anesthesia bag and manometer, and 100% oxygen should be administered. The pressure generated should begin at 20 to 25 cm H2O, with a rate of 40 to 60 breaths/minute. An adequate response to ventilation includes good chest rise, return of breath sounds, well-oxygenated color, heart rate returning to the normal range (120 to 160 beats/minute), normal end-tidal carbon dioxide, and, later, increased muscle activity and wakefulness. The usual recovery after a cardiac arrest first involves a return to a normal heart rate, followed by disappearance of cyanosis and noticeably improved perfusion. An infant may remain limp and be apneic for a prolonged time after return of cardiac output and correction of acidosis.
Breathing initially should be briefly delayed if meconium-stained amniotic fluid is present to avoid dissemination of meconium into the lungs, producing severe aspiration pneumonia. If meconium is noted in the amniotic fluid, the oropharynx should be suctioned when the head is delivered. After the birth of a depressed infant, the oral cavity should be
Table 58-9 Life-Threatening Congenital Anomalies NAME MANIFESTATIONS Choanal atresia (stenosis) Respiratory distress in delivery room, apnea, unable to pass nasogastric tube through nares Pierre Robin syndrome Micrognathia, cleft palate, airway obstruction
Diaphragmatic hernia Scaphoid abdomen, bowel sounds present in left chest, heart shifted to right, respiratory distress, polyhydramnios
Tracheoesophageal fistula Polyhydramnios, aspiration pneumonia, excessive salivation, unable to place nasogastric tube in stomach
Intestinal obstruction: volvulus, Polyhydramnios, bile-stained emesis, abdominal distention duodenal atresia, ileal atresia
Renal agenesis/Potter syndrome Oligohydramnios, anuria, pulmonary hypoplasia, pneumothorax
Neural tube defects: anencephaly, Polyhydramnios, elevated α-fetoprotein; decreased fetal activity meningomyelocele
Down syndrome (trisomy 21) Hypotonia, congenital heart disease, duodenal atresia
Ductal-dependent congenital heart Cyanosis, murmur, shock disease suctioned again; the vocal cords should be visualized and the infant intubated.
C represents circulation and external cardiac massage. Ifartificial ventilation does not improve bradycardia, if asystole is present, or if peripheral pulses cannot be palpated,external cardiac massage should be performed at a rate of 120 compressions/minute with compressions and breathsgiven at a ratio of 3:1. External cardiac massage usually is notneeded because most infants in the delivery room respondto ventilation.