Precautions and Monitoring of Newborn Resuscitation

Ⅰ. Precautions for newborn resuscitation

Newborn resuscitation is rarely treated with medication, and bradycardia is often caused by poor lung inflation and hypoxia. Establishing effective ventilation is the most important treatment method. After correct initial resuscitation, the heart rate is still <60 bpm, and epinephrine or volume expansion can be used. Treatment with alkaline fluids, narcotic antagonists or vasoconstrictors should be considered in individual cases.

Intravenous route of epinephrine (0.01-0.03mg/kg/time) has a positive effect. As the preferred route, if intravenous route cannot be implemented, intratracheal administration can be considered, and the dose can be increased to 0.1mg/kg/time. The efficacy and safety of the drug method have not been evaluated.

Naloxone is not used as a routine drug for respiratory depression. It is only used in infants who have been given anesthesia within 4 hours before delivery by the mother, and who have recovered heart rate, ruddy skin color, and persistent respiratory depression after positive pressure ventilation. There is no evidence of intratracheal administration, so intratracheal administration of naloxone is not recommended.

Hypothermia may reduce the extent of hypoxic, ischemic brain damage, but there is insufficient evidence. The routine application of hypothermia after newborn baby resuscitation is recommended, and further research is needed for which infants and which hypothermia method is more effective. Hyperthermia may exacerbate the degree of hypoxic-ischemic brain injury, and the goal is to achieve normothermia and avoid iatrogenic fever (hyperthermia).

Premature infants (<1500g) with very low birth weight are more likely to have hypothermia despite adopting various traditional warming techniques. For this reason, additional warming measures, such as the use of heating equipment, food grade polyethylene plastic thermal bags, are particularly recommended for very low birth weight premature infants. All measures aim to maintain normothermia.

Ⅱ. Monitoring after newborn resuscitation

1. The risk of multiple organ damage should continue to be monitored, including:

(1) Body temperature management.

(2) Monitoring of vital signs.

(3) Early detection of complications.

2. Continue to monitor and maintain the stability of the internal environment, including oxygen saturation, heart rate, blood pressure, hematocrit, blood sugar, blood gas analysis and blood electrolytes.

3. Blood gas analysis immediately after newborn baby resuscitation can help to estimate the degree of asphyxia. Monitor brain, heart, lung, kidney, and gastrointestinal functions in a timely manner, and detect abnormalities early to reduce death and disability caused by asphyxiation.

4. Blood sugar should be monitored regularly, and those with hypoglycemia should be given intravenous glucose.

5. If combined with moderate or severe hypoxic-ischemic encephalopathy, qualified departments can give mild hypothermia treatment.