Newborn-Neonatal-Resuscitation-Saving-Lives-in-the-First-Minute

[Audio] Newborn Neonatal Resuscitation: Saving Lives in the First Minute Every second counts when a newborn needs help breathing. Skilled, immediate intervention can mean the difference between life and death, between disability and a healthy future. By Dr.M.Alkawati.

[Audio] Why Neonatal Resuscitation Matters 10% <1% Need breathing support Need advanced care Approximately 10% of newborns require assistance to initiate breathing at birth Less than 1% require comprehensive resuscitation with advanced interventions 23% Preventable deaths Birth asphyxia accounts for nearly a quarter of neonatal deaths in some regions Prompt, skilled intervention during those critical first moments can prevent death and long-term neurological disability. Every healthcare provider attending births must be prepared to act swiftly and effectively..

[Audio] Anticipation & Preparation: The Foundation of Success Identify High-Risk Deliveries Prepare Equipment Screen for prematurity, foetal distress, maternal complications such as pre-eclampsia, meconium-stained fluid, or multiple gestations that may require immediate intervention Ensure readiness of radiant warmer, suction devices, bag-mask ventilation system, oxygen source, intubation tools, and emergency medications before delivery Assign Roles & Rehearse Designate clear team roles, establish communication protocols, and conduct briefings to ensure seamless coordination during resuscitation efforts.

[Audio] Initial Assessment: The Three Critical Questions Within seconds of birth, assess these three vital parameters to determine the need for resuscitation: Is the infant full term? Does the infant have good muscle tone? Is the infant breathing or crying? Gestational age affects thermoregulation and respiratory maturity, influencing resuscitation approach Spontaneous respirations or vigorous crying demonstrate effective air exchange and transition Active movement and flexed posture indicate neurological function and adequate oxygenation ✓ All "Yes" ✗ Any "No" Provide routine care with skin-to-skin contact, continuous monitoring, and support for breastfeeding initiation Move immediately to resuscitation under radiant warmer for warmth and complete assessment.

[Audio] The Golden Minute: First Steps of Resuscitation The first 60 seconds after birth are crucial. These rapid, sequential interventions can restore breathing and heart rate: Provide Warmth Dry infant thoroughly, remove wet linens, cover with warm blankets, and maintain temperature under radiant warmer to prevent hypothermia Position Airway Place infant in "sniffing position" with neck slightly extended to open airway and facilitate spontaneous breathing Clear Airway Gently suction mouth then nose if secretions present, limiting to 5 seconds maximum to avoid vagal stimulation Stimulate Breathing Provide tactile stimulation by rubbing back or flicking soles of feet to encourage spontaneous respirations Reassess Continuously Monitor breathing effort, heart rate, and colour throughout, adjusting interventions based on infant's response.

[Audio] Positive Pressure Ventilation (PPV) When to Initiate PPV Begin positive pressure ventilation immediately if the infant is apnoeic, gasping, or has a heart rate below 100 beats per minute after completing initial resuscitation steps. Technique Critical Importance Troubleshooting Use bag-mask device at 40-60 breaths per minute, delivering sufficient pressure to achieve visible chest rise with each breath Effective ventilation is the single most crucial intervention to improve heart rate and establish adequate oxygenation If ventilation proves ineffective, systematically check mask seal, head position, airway patency, and consider need for airway adjuncts.

[Audio] Advanced Interventions: Chest Compressions & Medications Chest Compressions Indication Initiate if heart rate remains below 60 bpm despite 30 seconds of effective positive pressure ventilation with good chest rise Compression Technique Use 3:1 ratio—three chest compressions to one ventilation—delivering 90 compressions per minute coordinated with 30 breaths per minute Medication Administration Epinephrine (adrenaline) rarely needed; reserved for cases where heart rate remains below 60 bpm after adequate ventilation and compressions Volume Expansion Consider isotonic crystalloid or blood products if significant blood loss suspected or infant appears pale with poor perfusion despite resuscitation.

[Audio] Umbilical Cord Management & Oxygen Use Delayed Cord Clamping Strategic Oxygen Management Waiting at least 60 seconds before clamping benefits preterm infants by reducing intraventricular haemorrhage, improving blood volume, and enhancing iron stores. Begin ventilation with room air (21% oxygen) for term infants. For preterm babies, titrate oxygen carefully based on pulse oximetry readings to meet target saturations whilst avoiding hyperoxia-related injury. Clinical Guidance: Use pulse oximetry from the first minute to guide oxygen delivery decisions. Target saturations increase progressively: 60-65% at 1 minute, 70-75% at 3 minutes, 80-85% at 5 minutes, and 85-95% at 10 minutes..

[Audio] Apgar Score: Monitoring Progress, Not Guiding Resuscitation Appearance Pulse Grimace Skin colour assessment: pink, acrocyanotic, or completely blue/pale Heart rate evaluation: absent, below 100, or above 100 beats per minute Reflex irritability response to stimulation: none, grimace, or cry Activity Respiration Muscle tone observation: limp, some flexion, or active movement Respiratory effort: absent, slow/irregular, or good crying Score 7-10 Score 4-6 Score 0-3 Normal range indicating good condition Moderately abnormal, requires monitoring Critically low, immediate intervention essential Assessed at 1 and 5 minutes (and every 5 minutes thereafter if low), the Apgar score guides continuation of resuscitation efforts and need for neonatal intensive care transfer, but never dictates initial resuscitation decisions..

[Audio] Conclusion: Key to Saving Newborn Lives The Golden Minute Early recognition, meticulous preparation, and prompt action within the first 60 seconds are the cornerstones of successful neonatal resuscitation Team Excellence Comprehensive team training, equipment readiness, and strict adherence to evidence-based algorithms ensure optimal outcomes Family-Centred Care Keeping mother and baby together whenever safely possible supports crucial bonding, breastfeeding initiation, and emotional recovery Continuous Improvement Ongoing education, simulation training, and quality improvement initiatives progressively enhance neonatal outcomes worldwide "Every newborn deserves the best possible start in life. With knowledge, preparation, and swift action, we can ensure that every baby has the chance to thrive.".