Objectives

On successfully completing this topic, you will be able to:

• understand the important physiological differences in the newly born baby

• understand the equipment used for resuscitation at birth

• understand how to assess and resuscitate the baby at birth

• understand additional measures for special situations.

Introduction

The resuscitation of babies at birth is different from the resuscitation of all other age groups, and knowledge of the relevant physiology and pathophysiology is essential. However, the majority of newly born babies will establish normal respiration and circulation without help. Ideally, someone trained in newborn resuscitation should be present at all deliveries. It is advisable that those who attend deliveries attend courses such as the Newborn Life Support Course, organised by the Resuscitation Council (UK), the European Resuscitation Council or the Neonatal Resuscitation Programme, organised by the American Academy of Pediatrics. However, some babies are born in unexpected places, such as Emergency Departments. For these situations, it is important that clinicians have an understanding of the differences in resuscitating a baby at birth.

Normal physiology

At birth the baby must change from an organism with fluid-filled lungs whose respiratory function is carried out by the placenta, to a separate being whose air-filled lungs can success fully take over this function. Preparation for this begins during labour, when the fluid-producing cells within the lung cease secretion and begin re-absorption of that fluid. Delivery by CS before the onset of labour may slow the clearance of pulmonary fluid from the lungs.