Delivery and Immediate Neonatal Care Book

How quickly should resuscitation be started?

Prompt resuscitation is the most effective. If the infant is apneic, gasping, or breathing
ineffectively after drying, clearing the airway, and providing additional stimulation, begin positive pressure ventilation. Usually the newborn will be less than 1 minute old (Figure 3).

Are delays or interruptions of resuscitation harmful?

Animal data indicate that delays in resuscitation significantly diminish its effectiveness. Experiences with adults show that even brief interruptions in resuscitation support are harmful.

Are there indications for not starting resuscitation?

Dramatic circumstances, such as extreme prematurity or severe congenital malformations, may be such indications. Clinical judgment and discussion with the parents should be emphasized.

If resuscitation has been done and life-sustaining therapies then seem undesirable, can treatments be stopped?

Most experts agree that resuscitation does not commit a child to future non-beneficial treatment.

If a baby does not respond to resuscitation, how long should the procedures be continued?

Consider stopping resuscitation if the infant has no heart rate or a heart rate below 60 beats per minute after 10 minutes of positive-pressure ventilation with all steps to improve positive-pressure ventilation. If the infant has a heart rate above 60 beats per minute, but does not breathe spontaneously, ventilation can be continued while seeking advanced care.