B.Initial steps of neonatal resuscitation include positioning and clearing the airway, stimulating the newborn to breathe, and assessing heart rate and oxygenation. Resuscitation efforts focus on airway establishment and adequate ventilation. C.Short- and long-term outcomes are linked to initial stabilization efforts, including warming the newborn; positioning; clearing the airway; drying the head, face, and body; and stimulating the newborn. Others steps that may be necessary include supplemental oxygen, assisting ventilation by providing positive pressure, intubation, chest compressions, and administering any needed medications. D.At birth, a fetus transitions from receiving oxygen from the placenta to receiving oxygen from breathing. A series of events must rapidly occur so the newborn can breathe. Delay of this decline in pulmonary pressure may lead to delayed transition, hypoxia, brain damage, and death.
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E.During delivery, use any available time to obtain a patient history and to prepare the environment and equipment you may need for neonatal resuscitation. F.The initial rapid assessment of the newborn may be done simultaneously with any interventions. Note patency of the airway, respiratory rate, respiratory effort, pulse rate, color, and capillary refill. G.The Apgar score determines the need for and effectiveness of resuscitation. It includes scores for appearance, pulse rate, grimace or irritability, muscle activity, and respiratory effort, obtained at 1 and 5 minutes after birth. H.Follow the neonatal resuscitation algorithm developed by the American Academy of Pediatrics and the American Heart Association. I.Thermoregulation is limited in the newborn, so take an active role in keeping body temperature in the normal range. Place the newborn directly on the mother’s chest, and dry the head and body with towels. Cover the newborn with a dry towel and the head with a cap. Position the newborn to ensure a patent airway. J.If the newborn does not respond in 30 seconds after initial stabilization efforts (bulb suctioning of the mouth and nose, drying, stimulation), further intervention is needed. 1.If normal breathing pattern and pulse rate of greater than 100 beats/min but still has central cyanosis of the trunk or mucous membranes, provide supplemental free-flow oxygen. 2.If still apneic or has a pulse rate of less than 100 beats/min, begin positive-pressure ventilation by bag-mask device. 3.If the pulse rate is less than 60 beats/min after 30 seconds of adequate positive-pressure ventilation, begin chest compressions. K.If the newborn is cyanotic or pale, administer warmed, humidified free-flow oxygen. If the newborn has an airway obstruction, insert an oral airway. If not effective and newborn is apneic, has inadequate respiratory effort, or is bradycardic, perform bag-mask ventilation. If this does not work, endotracheal intubation is required.
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