TY - CHAP M1 - Book, Section TI - Neonatal Resuscitation A1 - Eakin, Paul J. A2 - Tenenbein, Milton A2 - Macias, Charles G. A2 - Sharieff, Ghazala Q. A2 - Yamamoto, Loren G. A2 - Schafermeyer, Robert PY - 2019 T2 - Strange and Schafermeyer's Pediatric Emergency Medicine, 5e AB - The vast majority of newly-born term infants will respond adequately to tactile stimulation and warming. Very few will require significant resuscitation.Neonatal resuscitation is focused chiefly on respiratory support, not on cardiac support, unlike resuscitation for adults.Healthy term newborns may take 10 minutes or longer to reach normal extra-uterine oxygen saturations.The use of preductal pulse oximetry is recommended because skin color may correlate poorly with oxygen saturation.The use of 3-lead electrocardiogram (ECG) is the best secondary method to rapidly and accurately monitor the heart rate.The use of oxygen/air blenders is recommended to decrease exposure to 100% oxygen which has been increasingly shown to have toxic effects.When meconium-stained amniotic fluid is present, mouth and nasal suctioning after delivery of the head is not recommended for vigorous infants.Chest compressions are only initiated if there is no pulse or if the heart rate remains less than 60 beats/min after adequate positive-pressure ventilation (PPV) for 30 seconds.The ratio of chest compressions to ventilations during resuscitation should be 3:1, with 90 compressions and 30 ventilations per minute.Chest compressions are performed using the two-thumb–encircling hand technique.Auscultating for heart rate is more accurate than palpation of the umbilical cord base.The umbilical vein is the best site for intravenous (IV) access, but intraosseous access may be considered in the emergency department setting.Only isotonic crystalloid or packed red blood cells should be used for initial volume resuscitation.Epinephrine is indicated for a heart rate less than 60 beats/min after 30 seconds of adequate ventilation and chest compressions.The dose of epinephrine for the newly born infant is 0.1 to 0.3 mL/kg of 1:10,000 solution given intravenously. Higher doses are not recommended.Therapeutic hypothermia instituted after resuscitation may improve neurologic outcomes for term infants with hypoxic-ischemic encephalopathy (HIE). SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessemergencymedicine.mhmedical.com/content.aspx?aid=1155168320 ER -