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Initial Assessment
At birth the following characteristics are rapidly assessed to identify the need for resuscitation:
(a) Is the baby born after full term gestation?
(b) Is the amniotic fluid clear of meconium and evidence of infection?
(c) Is the baby breathing or crying?
(d) Does the baby have good muscle tone?
If the answer to all the questions is positive, the newborn does not require resuscitation.
- To prevent heat loss, the baby should be dried and covered in linen to maintain body warmth.
- In preterm babies, especially those with gestation age <28>
- The newborns' color, breathing and activity should be continuously assessed.
If the answer to any one of the above questions is negative, the neonate would require one or more of the following actions in sequence:
A. Initial steps in stabilization (clearing the airway, positioning, stimulating)
B. Ventilation
C. Chest compressions
D. Medication/s and volume expansion.
Progress to the next step in the sequence is based on simultaneous assessment of the three vital signs:
- respiration,
- heart rate
- and color.
Approximately 30 sec have been allocated to complete one step successfully,
re-evaluate and decide whether to progress to the next step.
Respiratory activity The neonates' breathing should be checked.
- Rate,
- depth
- and symmetry of respiration should be evaluated.
- Any abnormal breathing patterns such as gasping or grunting should be noted.
- Heart rate Palpation of the pulse below the umbilical cord has been found to be reliable only if heart rate is more than 100 beats/minute. [4]
- Heart rate is best evaluated by auscultation.
- Colour Although a healthy baby is born blue, the color becomes pink within 30 seconds of the start of effective breathing.
- A healthy neonate achieves and maintains pink mucous membranes without supplementary oxygen.
- Evaluation of central cyanosis is done by examining the face, trunk and mucous membranes. Peripheral cyanosis is often observed and does not by itself indicate hypoxemia.
- Pallor or mottling is seen in neonates having decreased cardiac output, hypovolemia, severe anemia, hypothermia or acidosis.
- Tone If the neonate is very floppy, it is most likely unconscious and would require respiratory support.
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