Neonatal resuscitation is the process of assisting a newborn who is struggling to breathe or transition to life outside the womb immediately after birth. When a newborn fails to take adequate breaths or establish a stable heart rate, immediate intervention is required. A quick, pre-prepared equipment checklist is paramount to ensure readiness and facilitate a rapid, organized response. This equipment list is organized by function to allow healthcare providers to confirm availability and functionality swiftly.
Preparing the Environment: Thermal Regulation and Monitoring Tools
A newborn’s ability to maintain body temperature is fundamental to a successful transition, making thermal regulation equipment a priority. The primary device is a pre-heated radiant warmer, which provides an open, controlled environment for procedures while minimizing heat loss. Warm blankets and towels are necessary to dry the infant immediately after birth, which significantly reduces evaporative heat loss. For extremely premature infants (less than 32 weeks gestation), specialized items like polyethylene plastic wrap or bags and a thermal mattress are used to conserve body heat.
The team monitors the baby’s response using specific assessment tools. A stethoscope with a neonatal head allows the team to accurately auscultate the heart rate and confirm air entry into the lungs. The pulse oximeter, with its sensor and cover, measures pre-ductal oxygen saturation (SpO2) and heart rate, typically placed on the right hand or wrist. Monitoring is guided by a Target Oxygen Saturation Table, which dictates the appropriate oxygen concentration to administer based on the infant’s age in minutes.
Establishing the Airway: Suction and Intubation Supplies
The first step in managing a distressed newborn is clearing the airway of secretions or fluid. A bulb syringe provides the most immediate and gentle method for suctioning the mouth and nose. If deeper suction is required, mechanical suction apparatus must be ready, with the wall suction set to a pressure of 80 to 100 mm Hg. Suction catheters, typically sizes 5F or 6F and 10F, are necessary for pharyngeal and deep tracheal suctioning.
If the baby’s condition does not improve, securing the airway via intubation becomes necessary. This requires a laryngoscope handle and straight blades (size 0 for preterm infants and size 1 for term infants). Endotracheal tubes (ETTs) in internal diameters of 2.5, 3.0, and 3.5 mm must be readily available to accommodate newborns of different sizes. Once the tube is placed, a carbon dioxide (\(\text{CO}_2\)) detector confirms correct placement in the trachea, turning yellow to indicate the presence of exhaled \(\text{CO}_2\).
Supporting Respiration: Ventilation Devices and Oxygen Delivery
The core of neonatal resuscitation involves establishing effective breathing, which often requires positive pressure ventilation (PPV). Devices for PPV include self-inflating bags, flow-inflating bags, or T-piece resuscitators, all of which must be tested before use. The T-piece resuscitator is a common device that allows for precise control of the peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP). Ventilation often starts with 20 to 25 cm of water for PIP and 5 cm of water for PEEP. Face masks of both term and preterm sizes are needed to create a tight seal for effective ventilation.
Oxygen delivery is precisely managed using an oxygen source, a compressed air source, and a blender to mix the two gases. The flowmeter should be set to 10 L/min to ensure adequate flow for the resuscitation device. Ventilation is initiated with a low oxygen concentration, such as 21% (room air) for term infants, and slightly higher (21%–30%) for preterm infants. The concentration is adjusted based on pulse oximeter readings and target saturation goals. For prolonged ventilation, an 8F orogastric tube and a 20-mL syringe are needed to decompress the stomach and prevent breathing compromise.
Ensuring Circulation: Medications and Vascular Access Equipment
If the newborn remains severely bradycardic (heart rate below 60 beats per minute) despite adequate ventilation and chest compressions, medications are required. The primary medication is Epinephrine, prepared as a 1:10,000 solution (0.1 mg/mL). Pre-calculated dosage tables ensure the correct amount is administered, typically 0.01 to 0.03 mg/kg intravenously.
This medication requires rapid vascular access, with the umbilical vein being the preferred route in the delivery room. Supplies for placing an emergency umbilical venous catheter (UVC) must be ready, including:
- An antiseptic solution
- Umbilical tape
- A scalpel
- A 3.5F or 5F single-lumen catheter
Normal saline is needed for flushing the catheter and as a volume expander to address potential blood loss or shock. This advanced intervention is prepared immediately upon considering the need for chest compressions, as correct placement is time-sensitive.