Clinical Review ABC of labour care

Care of the newborn in the delivery room

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7195.1403 (Published 22 May 1999) Cite this as: BMJ 1999;318:1403
  1. Patricia Hamilton

    It is the duty of those attending a delivery to ensure that the baby is given any resuscitation that may be needed and to do a brief external examination of the baby to exclude immediate problems. Any risk factors for sepsis or other neonatal problems should be communicated to the paediatricians.

    Triangle of resuscitation—relative frequencies and priorities for neonatal resuscitation

    Resuscitation

    Most newborn babies will establish normal breathing spontaneously. They need only attention to the maintenance of their temperature and perhaps gentle stimulation to start breathing; some may need suction of the airway, and a few will need assisted lung inflation via a mask. Fewer still need tracheal intubation, and very few indeed will need external chest compression and intervention with drugs.

    At every delivery, wherever it takes place, there should be at least one person who is responsible for giving basic care to the baby, initiating resuscitation if necessary, and summoning more help if needed (British Paediatric Association, 1993)

    Successful resuscitation requires the coordinated efforts of a professional team. All midwives, neonatal nurses, and doctors who might attend a delivery should be competent in lung inflation and ventilation via a mask. Tracheal intubation should be undertaken only by those who have been trained in its use and who have sufficient practice to maintain the skill.

    Physiology

    The first few breaths overcome the surface tension within the lung, drive any residual fluid from the alveoli into the circulation, and fill the lungs with air. Once the initial opening pressure has been achieved, subsequent breaths need not be so forceful.

    Conditions in which neonatal resuscitation may be needed*

    • Fetal distress

    • Thick meconium staining of amniotic fluid

    • Vaginal breech deliveries

    • Gestation of <32 completed weeks

    • Serious congenital abnormality

    • Concern of attending staff

    *Someone experienced in resuscitation, and an assistant, should be present

    In utero little blood flows to the lungs because of …

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