NEONATAL RESUSCITATION PREPARATION

PREPARATION FOR NEONATAL RESUSCITATION
A number of sources of information concerning the training of skills and procedures that are needed for the delivery room resuscitation of the newborn are available. One highly respected source of information concerning the preparation and practice of neonatal resuscitation is the Neonatal Resuscitation Program, which has been codeveloped by the AAP and the American Heart Association. The following sections contain a review of resuscitation procedures in a format that is similar to the format used by the Neonatal Resuscitation Program. Completion of the Neonatal Resuscitation Program should be considered for all hospital personnel who may be involved in the stabilization and resuscitation of neonates in the delivery room. To develop true expertise, additional supervised time with skilled personnel is essential.

Although the current program for neonatal resuscitation is considered a highly respected reference, it is important that more research continue to evaluate the effectiveness of the techniques of neonatal resuscitation. The Neonatal Resuscitation Program has evolved and will continue to evolve with new data from clinical studies and basic physiologic research.

Anticipation
The goals of resuscitation are to assist with the initiation and maintenance of adequate ventilation and oxygenation, adequate cardiac output and tissue perfusion, and normal core temperature and serum glucose. These goals may be attained more readily when risk factors are identified early, neonatal problems are anticipated, equipment is available, personnel are qualified and available, and a care plan is formulated.

Causes of depression and asphyxia
A large number of antepartum and intrapartum maternal conditions carry an increased risk for intrapartum asphyxia. A number of excellent texts review the extensive medical and surgical problems of the obstetrical patient. It is not within the purview of this article to review this topic.

Equipment
The delivery room should be equipped with all the necessary tools to successfully resuscitate any gestational age newborn. The equipment should include a radiant warmer, warmed blankets, a source of oxygen, instruments for visualizing and establishing an airway, a source of regulated suction, instruments and supplies for establishing intravenous access, trays equipped for emergency procedures, and drugs that may be useful in resuscitation. The following table outlines the minimum equipment necessary for each of these categories.

Trained personnel
For all deliveries, at least one person should be present who is skilled in neonatal resuscitation and has responsibility for only the infant. Personnel should be available who are capable of performing a complete resuscitation, including intubation, medication administration, and emergency procedures. If the delivery is identified as high risk, 2 or more skilled individuals should be assigned for the infant at delivery. Remember that staff trained in neonatal resuscitation need to apprentice with experienced personnel for some time before they can be independently responsible for an infant at a delivery.