Preparation

1.2. Preparing for resuscitation

The need for resuscitation of the newborn infant at birth cannot always be anticipated nor predicted. Therefore, at every birth, no matter how “low risk”, the birth team must be prepared to resuscitate the newborn infant.

Preparing for resuscitation of a newborn infant requires:

  • Identification of maternal, fetal and intrapartum factors that place the newborn infant at risk of requiring resuscitation.
  • Communication between the person(s) caring for the mother and those responsible for receiving the newborn regarding antepartum and intrapartum factors that place the newly born infant at risk.
  • Having a complete set of resuscitation equipment and drugs available at all births (see the list below).
  • Providing a clean and warm environment for the birth.
  • Skilled professional staff having appropriate qualifications and experience in newborn resuscitation:
    • At least one person should be solely responsible for the care of the newly born infant
    • All staff who attend births should be trained in basic newborn resuscitation
    • A person trained in advanced newborn resuscitation should be available for low risk births and in attendance at all high risk births

A team approach to caring for the mother and her newborn and to providing appropriate newborn resuscitation techniques, should these be needed.

 

  • ANZCOR recommend prior preparation of standardised equipment kits to save time in an emergency 
  • Such kits should contain equipment needed for procedures such as umbilical catheterisation 

         ANZCOR, 2021, Guideline 13.1

 

Recommended equipment and drugs for resuscitation of the newborn

Click here for a list of equipment and drugs for resuscitation of the newborn  Updated July 2021

Appropriate area for resuscitation of the newborn 

  • Infant resuscitaire with in-built heater and light, or
  • A firm, padded resuscitation surface and an overhead warmer
  • Clock with timer in seconds
  • Good light in the resuscitation area
  • Appropriate personal protective equipment (PPE) according to the level of risk (see section on COVID-19 positive or suspected COVID-19 positive newborns at the end of this page)

Temperature maintenance

  • Warmed towels or warm wraps
  • Polyethylene bag or sheet (food grade, heat resistant) for infants less than 32 weeks’ gestation or less than 1500 grams birth weight
  • Woollen hats (various sizes)

Monitoring equipment

  • Stethoscope (neonatal size)
  • Pulse oximeter with a neonatal sensor
  • A posy to secure the oximeter sensor
  • ECG monitor, leads and appropriately sized ECG ‘dots” for term and preterm infants (if available)

Suction equipment

  • Suction catheters: Fg 6 and Fg 8 and either a Fg 10 or Fg 12
  • Suction tubing
  • Access to a suction unit set at a negative pressure of 100 mmHg (133 cmH2O, 13 kPa or 1.9 Psi)
  • Meconium suction device to apply suction directly to the endotracheal tube (optional)

Positive pressure ventilation equipment

Either:

  • T-piece device (e.g. Neopuff™ or NeoPIP™) OR
  • Flow inflating bag (e.g. anaesthetic bag) with a pressure safety valve and a manometer

AND:

  • Self inflating bag (<300mL) with a removal oxygen reservoir (plus a manometer and PEEP valve, if available)
  • Face masks in a range of sizes suitable for term and preterm infants
  • Supraglottic airway (Laryngeal mask airway™ or i-gel™): size 1
  • Oropharyngeal (Guedel) airways sizes 0 & 00 (50mm and 60mm)

Medical gases

  • A source of medical oxygen (cylinder or reticulated)
  • A source of medical air (cylinder or reticulated)
  • Oxygen flow meter allowing a flow rate of up to 10 L/minute
  • Air flow meter allowing a flow rate of up to 10 L/minute
  • Oxygen and air tubing (green argyle tubing)
  • Air/oxygen blender (If a blender is not available, a Y- connector can be used between the air and oxygen flow meters and the flow rates adjusted to achieve the desired oxygen concentration

Intubation equipment

  • Laryngoscopes with straight blades: sizes 00, 0 & 1
  • Spare batteries and bulbs (unless using a fibre optic laryngoscope handle)
  • Endotracheal tubes (un-cuffed): sizes 2.5, 3.0, 3.5, 4.0 mm ID
  • Endotracheal stylet or introducer (for oral intubation only)
  • End tidal colorimetric carbon dioxide detector (Pedi-Cap™, Nellcor™,) or similar
  • Magill’s forceps, neonatal size (optional)

Equipment for gastric decompression

  • Feeding tubes: sizes Fg 8 & Fg 10
  • 10mL syringe for aspirating the gastric contents

Equipment for umbilical venous catheterisation (UVC) 

  • Paediatric instrument set
  • Umbilical catheters:
    • Fg 3.5 < 1000 gram infant
    • Fg 5.0 or Fg 4.0 > 1000 gram infant
  • The complete equipment list for umbilical venous & arterial catheterisation can be accessed from the Neonatal e-Handbook  (Better Safer Care Victoria)

Equipment for peripheral  intravenous (IV) or intraosseous (IO) cannulation

  • Intravenous cannula: size Fg 24
  • Intraosseous needle Fg 18 and IO gun (if available) neonatal size 15 mm)
  • Skin preparation solution
  • Three way tap and/or luer lock extension tubing primed with 0.9% sodium chloride
  • Arm board (for peripheral cannulation)

Equipment for securing an endotracheal tubes (ETT), UVC, IV and IO

  • Tapes and devices for securing ETT, UVC, IV and IO
    • Non-latex adhesive tape (Leukoplast™ & Elastoplast™) or ETT holder (NeoBar™)
    • Cotton or silk ties (optional)
    • Hydrocolloid dressing (DuoDerm™ or Coloplast™) to protect the skin on the face
  • Scissors

Equipment for drug administration

  • Syringes: 2 mL, 5 mL, 10 mL & 20 mL
  • Needles: Fg 19, Fg 21, Fg 23, Fg 25 and blunt drawing up needles

Drugs

  • Adrenaline 1:10,000 concentration (0.1 mg/mL)
  • Volume expanders:
    • 0.9% sodium chloride
    • O Rh negative blood needs to be readily available
  • 0.9% sodium chloride for priming and flushing intravenous lines

Resuscitation Record Sheet

Preparation for specific neonatal conditions

Preterm infant <32 weeks’ gestation or less than 1500 grams

  • Prepare a polyethelene bag or sheet/wrap
  • If using  a polyethylene bag: cut a square hole (large enough for the infant’s head) into the end opposite the zip lock
  • At birth, the infant’s body (but not the head) should be placed immediately into the bag or wrap (wet and warm) and directly under a radiant heat source
  • The infant’s head should be dried and a woollen hat placed onto the infant’s head

The infant born through meconium stained amniotic fluid

  • Connect a large bore suction catheter (Fg 10 or Fg 12) to the suction device in preparation for oropharyngeal suctioning
  • Have intubation equipment readily available

Multiple births (especially if premature)

  • Provide a fully equipped resuscitaire for each infant if possible
  • At least one person with advanced resuscitation skills must be available for each infant

Antenatal diagnosis of an airway abnormality

  • Have an appropriate sized supraglottic airway (laryngeal mask airway™ or i-gel™): size 1 available
  • Have oropharyngeal (Guedel) airways available
  • Have an anaesthetist available to assist with airway management if possible

Antenatally diagnosed congenital anomaly that is usually incompatible with life

  • Trisomy 13, 18, anencephaly or extreme prematurity (<23 weeks’ gestation/ <400 grams).
  • Parents should ideally be counselled and an informed decision made before the birth (when possible) regarding withholding or withdrawing treatment

COVID-19 positive or suspected COVID-19 positive mother and/or newborn 

  • Personal protective equipment (PPE), including N95 face mask, face shield, gown, gloves
  • Consideration should be given to preparing a dedicated equipment box and separate resuscitation trolley for these patients with COVID-19 specific equipment

 

Previous Next