First steps are to warm the baby, position the baby (sniffing position), dry and
stimulate the baby to breathe (slap or flick soles of feet, gently rub back. Assess HEART
RATE, RESPIRATIONS, and COLORHR needs to be >100 beats per minute (8 beats in 6 seconds)Blow-by O 2 should be quickly offered to any child not “pinking-up” quick enough.
If there is no response to blow-by O2, positive-pressure ventilation (PPV) should be
administered with bag-valve-mask should established. Intubation should follow if there
is no further response. PIP should be less than 20 mm Hg, with rates of 30
breaths/minute.CPR is rarely needed in the delivery room. Bradycardia is almost always due to a
suboptimal airway and failure to achieve adequate oxygenation. When necessary, 90
compressions per minute are given (1 breath per 3 compressions per minute, resulting
in 120 events/minute)Management of the circulation generally takes place in the NICU. Occasionally
difficult resuscitations require volume expansion in the delivery room. Normal saline
(NS) 10-15 cc/kg given as a push (given over 30-60 minutes for preemies) is usually the
most readily accessible form of volume expansion. An umbilical venous catheter may
need to be placed in an urgent fashion.