See<unk>  critical care quick reference for drug doses and equipment sizes.
If yes, stay with mother for routine care (clear secretions, dry, warm and maintain temperature)
Delay cord clamping/cutting for 30-60 seconds
Presence of meconium no longer changes care (i.e. is not an indication for intubation)
If no:
Respiration: adequacy, difficulty
Circulation: HR >100, palpate at umbilical base or auscultate for HR
Color - central cyanosis?
Delay cord clamping/cutting for 30-60 seconds
Presence of meconium no longer changes care (i.e. is not an indication for intubation)
Respiration: adequacy, difficulty
Circulation: HR >100, palpate at umbilical base or auscultate for HR
Color - central cyanosis?
Gently dry<unk>  with warm towel
Position: neutral (sniffing position)
Consider slight extension with rolled diaper or small towel under the infant's shoulders to maximize air entry and avoid obstruction. (Do not place under neck; Do not hyperextend which can cause airway obstruction as well!) 
Suction: oral then nasal
Mouth before nose (remember: M before N in alphabet)
Suctioning in this order avoids aspiration if infant takes breath after suctioning nose 
Stimulate: along spine or feet
Check glucose
D10W (2-4 mL/kg = 0.2gm/kg)
If patient >2.5 kg and glucose <40mg/dL
If patient <2.5 kg and glucose <30mg/dL
Consider slight extension with rolled diaper or small towel under the infant's shoulders to maximize air entry and avoid obstruction. (Do not place under neck; Do not hyperextend which can cause airway obstruction as well!) 
Mouth before nose (remember: M before N in alphabet)
Suctioning in this order avoids aspiration if infant takes breath after suctioning nose 
D10W (2-4 mL/kg = 0.2gm/kg)
If patient >2.5 kg and glucose <40mg/dL
If patient <2.5 kg and glucose <30mg/dL
If patient >2.5 kg and glucose <40mg/dL
If patient <2.5 kg and glucose <30mg/dL
Continue to be apneic or gasping? HR below 100? (assess HR by: auscultation, 3 lead ECG, or umbilical cord palpation)
PPV/BVM x 30 seconds (40-60 breaths/min @ 20-25 cmH20)
SpO2 monitor: Place O2 sat monitor preductal (right hand or wrist)
Initial resuscitation >35 weeks 21% FiO2, < 35 weeks 21-30% FiO2
Titrate O2 to target sat (see table above; hyperoxia can be harmful)
PPV/BVM x 30 seconds (40-60 breaths/min @ 20-25 cmH20)
SpO2 monitor: Place O2 sat monitor preductal (right hand or wrist)
Initial resuscitation >35 weeks 21% FiO2, < 35 weeks 21-30% FiO2
Titrate O2 to target sat (see table above; hyperoxia can be harmful)
If patient on reexam just has persistent cyanosis or labored breathing:
For improving ineffective ventilation, think MRSOPA
Mask is tightly applied to the face
Re-position the head into the “sniffing” orientation
Suction the nares and the pharynx
Open the mouth
Pressure of PPV can be increased to a max of 40 cm H2O
Alternate airway, i.e. ET, should be considered and planned for
For improving ineffective ventilation, think MRSOPA
Mask is tightly applied to the face
Re-position the head into the “sniffing” orientation
Suction the nares and the pharynx
Open the mouth
Pressure of PPV can be increased to a max of 40 cm H2O
Alternate airway, i.e. ET, should be considered and planned for
Mask is tightly applied to the face
Re-position the head into the “sniffing” orientation
Suction the nares and the pharynx
Open the mouth
Pressure of PPV can be increased to a max of 40 cm H2O
Alternate airway, i.e. ET, should be considered and planned for
If HR continues to be below 100
Check chest movement and make sure patient is being ventilated appropriately
Ventilation corrective steps (MRSOPA)
If ventilation not improving, intubate patient and continue resuscitation until HR > 100 BPM
ET (indications); ETT size = Gest age (wks) / 10^^
Laryngeal mask airway alternative
If patient HR < 60 BPM on reassessment
Intubate if not already done
Chest Compressions
Aim for 120 compressions per min (Respirations 3:1), stop when HR > 60
For compressions, wrap hands around patient's thorax and use thumbs to compress anterior chest wall
Consider Epi (0.01-0.03mg/kg) if:
HR<60 despite above intervention
Use only 1:10,000 (0.1mg/kg concentration)
Check chest movement and make sure patient is being ventilated appropriately
Ventilation corrective steps (MRSOPA)
If ventilation not improving, intubate patient and continue resuscitation until HR > 100 BPM
ET (indications); ETT size = Gest age (wks) / 10^^
Laryngeal mask airway alternative
ET (indications); ETT size = Gest age (wks) / 10^^
Laryngeal mask airway alternative
Intubate if not already done
Chest Compressions
Aim for 120 compressions per min (Respirations 3:1), stop when HR > 60
For compressions, wrap hands around patient's thorax and use thumbs to compress anterior chest wall
Consider Epi (0.01-0.03mg/kg) if:
HR<60 despite above intervention
Use only 1:10,000 (0.1mg/kg concentration)
Aim for 120 compressions per min (Respirations 3:1), stop when HR > 60
For compressions, wrap hands around patient's thorax and use thumbs to compress anterior chest wall
HR<60 despite above intervention
Use only 1:10,000 (0.1mg/kg concentration)
For prolonged code (HR < 60) consider hypovolemia and pneumothorax
D10W (2-4 mL/kg = 0.2gm/kg)
NS (10 mL/kg boluses)
PRBC 10mL/kg if abruption with anemia
Dopamine drip
(5-20 mcg/kg/min)
NaHCO3 - prolonged resuscitation
(1-2 meQ/kg)
Naloxone
In past, used for opioid use <4hrs, however no longer recommended as can precipitate acute withdrawal and seizures if prolonged intrauterine exposure. Overall effect unknown, therefore respiratory support preferred to using naloxone .
(5-20 mcg/kg/min)
(1-2 meQ/kg)
In past, used for opioid use <4hrs, however no longer recommended as can precipitate acute withdrawal and seizures if prolonged intrauterine exposure. Overall effect unknown, therefore respiratory support preferred to using naloxone .
Pressure Cycled: RR 30+, PIP 20/2 (Preemie 15/2)
Optimize
Position head in sniffing position
Suction mouth then nose
Intubate
Indicated if patient is poorly responsive or fails BVM
If have time precut ET tube at 13cm mark
Lip placement = 6 + wt (kg)
Or, lip placement = measure nasal septum to tragus length (NTL) in cm + 1
After intubation suction trachea to prevent aspiration (if +meconium; however, meconium is no longer an indication for intubation)
Position head in sniffing position
Suction mouth then nose
Indicated if patient is poorly responsive or fails BVM
If have time precut ET tube at 13cm mark
Lip placement = 6 + wt (kg)
Or, lip placement = measure nasal septum to tragus length (NTL) in cm + 1
After intubation suction trachea to prevent aspiration (if +meconium; however, meconium is no longer an indication for intubation)
Umbilical vein is site of choice
NS 10mL/kg IV or umb vein over 5-10min
O Rh-negative blood if abruption/anemic
Epinephrine
Indicated for asystole or HR < 60 despite CPR >30s
0.01-0.03mg/kg IVP q3-5min
Sodium bicarbonate
Helps to counteract negative inotropy/pulmonary hypertension caused by acidosis
Only give once adequate ventilation is established
1-2 mEq/kg of 4.2% solution (2-4 mL/kg)
Naloxone
Previously given if persistent respiratory depression AND maternal opioids within 4hr
No longer recommended; assist ventilations as needed until opioids wear off
0.1-0.4mg/kg IV
Indicated for asystole or HR < 60 despite CPR >30s
0.01-0.03mg/kg IVP q3-5min
Helps to counteract negative inotropy/pulmonary hypertension caused by acidosis
Only give once adequate ventilation is established
1-2 mEq/kg of 4.2% solution (2-4 mL/kg)
Previously given if persistent respiratory depression AND maternal opioids within 4hr
No longer recommended; assist ventilations as needed until opioids wear off
0.1-0.4mg/kg IV
Delay cord clamping 30-60 seconds if able
Keep infant warm; heat loss leads to apnea, acidosis
Consider placing body in plastic bag to prevent heat loss
Consider placing body in plastic bag to prevent heat loss
Newborn resuscitation
Neonatal resuscitation
Hypoxia
Baby feeding and nutrition
Primary apnea
Umbilical vein catheterization
Secondary apnea
Prehospital protocol pediatric respiratory failure