How to Perform Neonatal Cardiopulmonary Resuscitation (CPR)?

Introduction:

Neonatal cardiopulmonary resuscitation (CPR) is a critical lifesaving technique used to support newborns who experience cardiorespiratory arrest or severe distress. Newborns, especially those born prematurely or with congenital conditions, may require immediate resuscitation to establish effective breathing and circulation. Understanding and mastering the correct techniques for neonatal CPR is essential for healthcare providers to ensure the best possible outcomes for these vulnerable patients.

Steps for Performing Neonatal CPR

Initial Assessment and Preparation

1. Ensure Safety and Warmth:
   • Ensure the environment is safe and free from hazards for Neonatal CPR.
   • Maintain the newborn’s body temperature by using warm towels or blankets.
2. Stimulate the Newborn:
   • Gently stimulate the newborn by rubbing the back or flicking the soles of the feet to encourage spontaneous breathing.
3. Evaluate Respiratory Effort and Heart Rate:
   • Assess the newborn’s breathing and heart rate for neonatal CPR. If the newborn is not breathing or has a heart rate below 100 beats per minute, initiate resuscitation.

Airway Management

1. Position the Head:
   • Place the newborn on a flat, firm surface.
   • Position the head in a neutral or slightly extended position to open the airway. Avoid hyperextension or flexion.
2. Clear the Airway:
   • If there is visible obstruction, gently suction the mouth and nose using a bulb syringe or suction catheter.

Breathing Support

1. Provide Positive Pressure Ventilation (PPV):
   • If the newborn is apneic or has gasping respirations, provide PPV using a bag-mask device or T-piece resuscitator.
   • Ensure a proper seal with the mask over the nose and mouth.
   • Deliver breaths at a rate of 40-60 breaths per minute. Each breath should be just enough to see the chest rise.
2. Assess Effectiveness:
   • After 30 seconds of PPV, reassess the heart rate. If the heart rate is below 60 beats per minute, continue with PPV and proceed to chest compressions.

Circulation Support

1. Start Chest Compressions:
   • Place two thumbs on the lower third of the sternum, with the fingers encircling the thorax and supporting the back.
   • Alternatively, use the two-finger technique if preferred.
   • Compress the chest to a depth of approximately one-third of the anterior-posterior diameter of the chest.
2. Compression-to-Ventilation Ratio:
   • Perform chest compressions at a rate of 90 compressions per minute.
   • Coordinate compressions with ventilations using a 3:1 ratio (three compressions followed by one breath).

Reassess and Continue

1. Reassess Heart Rate:
   • After 60 seconds of coordinated chest compressions and ventilations, reassess the heart rate.
   • If the heart rate remains below 60 beats per minute, continue CPR and consider the need for additional interventions.
2. Administer Medications if Needed:
   • If there is no improvement with effective ventilation and compressions, administer epinephrine as per neonatal resuscitation guidelines.
3. Monitor and Adjust:
   • Continuously monitor the newborn’s response to resuscitation.
   • Adjust the resuscitation efforts based on the heart rate, respiratory effort, and overall clinical status.

Neonatal CPR Guidelines:

American Heart Association (AHA) Guidelines

The AHA provides comprehensive guidelines for neonatal CPR, emphasizing the importance of prompt and effective interventions. Key recommendations include:

1. Initial Steps:
   • Dry and warm the newborn.
   • Clear the airway if necessary.
   • Stimulate to initiate breathing.
2. Ventilation:
   • Start PPV if the newborn is not breathing or has a heart rate below 100 beats per minute.
   • Use a bag-mask device or T-piece resuscitator to deliver breaths.
3. Chest Compressions:
   • Initiate chest compressions if the heart rate remains below 60 beats per minute despite adequate ventilation.
   • Use the two-thumb encircling technique or the two-finger technique for chest compressions.
4. Oxygen Use:
   • Begin resuscitation with room air (21% oxygen) for term infants.
   • Adjust oxygen concentration based on preductal pulse oximetry readings to achieve targeted oxygen saturation levels.
5. Medications:
   • Administer epinephrine if the heart rate remains below 60 beats per minute after effective ventilation and chest compressions.
   • Consider volume expansion for suspected hypovolemia.
6. Post-Resuscitation Care:
   • Monitor vital signs and oxygen saturation.
   • Provide supportive care to maintain normal body temperature, glucose levels, and blood pressure.
   • Prepare for potential transport to a neonatal intensive care unit (NICU) for ongoing management.

Key Points for Healthcare Providers

1. Team Coordination:
   • Effective neonatal resuscitation requires teamwork and clear communication among healthcare providers.
   • Designate roles and responsibilities before initiating resuscitation.
2. Continuous Training:
   • Regular training and simulation exercises for neonatal resuscitation improve skills and confidence.
   • Healthcare providers should stay updated with the latest guidelines and best practices.
3. Parental Communication:
   • Provide timely and compassionate communication with parents during and after the resuscitation process.
   • Explain the steps taken and the newborn’s condition clearly and empathetically.

Conclusion

Neonatal CPR is a critical intervention that can save the lives of newborns experiencing cardiorespiratory distress. Healthcare providers must be well-versed in the steps and guidelines for performing effective neonatal resuscitation. By following established protocols, maintaining effective communication, and participating in regular training, providers can ensure they are prepared to deliver the highest standard of care to newborns in need.

FAQs:

When is neonatal CPR necessary?

Neonatal CPR is necessary in situations of respiratory distress, apnea, or cardiac arrest, where the newborn’s breathing or heartbeat is compromised and requires immediate intervention to sustain life.

What are the steps for performing CPR on a newborn?

The steps for performing CPR on a newborn include assessing responsiveness, activating emergency medical services, providing 30 chest compressions (at a rate of 100-120 per minute) with two fingers, followed by two rescue breaths, maintaining a ratio of 30:2, and continuing cycles of CPR until help arrives or signs of life return.

How does neonatal CPR differ from CPR on adults?

Neonatal CPR differs from CPR on adults in several ways: it requires gentler and smaller compressions, often using two fingers instead of the full hand, and the depth and rate of compressions are adjusted to the newborn’s size and needs. Additionally, the technique for providing rescue breaths is modified to accommodate the infant’s smaller airway.

What are the risks associated with neonatal CPR?

Risks associated with neonatal CPR include rib fractures, damage to internal organs, and complications related to excessive force during chest compressions. Additionally, there is a risk of aspiration if rescue breaths are delivered too forcefully or incorrectly.

Can CPR save a newborn’s life?

Yes, CPR can save a newborn’s life by providing immediate intervention to restore breathing and circulation in situations of respiratory distress, apnea, or cardiac arrest. Early initiation of CPR can significantly improve the chances of survival and reduce the risk of long-term complications.