Posted by Andy Jagoda MD in: Brain Tease , trackback
Although most neonates will not require resuscitation, emergency clinicians must be prepared to manage neonates who require respiratory assistance.
Our recent issue Neonatal Resuscitation in the Emergency Department reviews current expert recommendations and consensus updates of the best practices in resuscitation of neonates.
An overview of neonatal physiology provides a framework for understanding how neonatal resuscitation differs from that of children and adults. A step-wise, systematic approach is provided for identifying and managing newborns who require resuscitation. The treatment, management, and over-arching goals for neonatal resuscitation and newborn care are also reviewed.
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Here are a few key points:
- By the first minute of life, the normal neonate’s oxygen saturation (SpO2) is 60% to 65%, and it will increase steadily, by 10% approximately every 2 minutes. For example, by 3 minutes of life, a normal SpO2 is 70% to 75%; by 5 minutes, 80% to 85%. Only after approximately 10 minutes of life will the full-term, healthy neonate exhibit an SpO2 of 85% to 100%.
- If initiating positive pressure ventilation, ideal positive end-expiratory pressure is 5 cm H2O and peak inspiratory pressure is 20 to 25 cm H2O.
- When obtaining intraosseous access, placement should be 1 cm inferior to the patella and 1 cm medial to the tibial tuberosity (as opposed to 2 cm for older children and adults)
- When placing an umbilical venous catheter for resuscitation, it should be only deep enough for blood return.