Newborn Life Support (NLS)
Resuscitation Council UK Newborn resuscitation and support of transition of infants at birth Guidelines
Background Information
APGAR score should be recorded routinely at 1 min and 5 min after birth
| Component | 0 points | 1 points | 2 points |
|---|---|---|---|
| Appearance | Blue / pale completely | Peripheral cyanosis only | Pink |
| Pulse (heart rate) | 0 | <100 | >100 |
| Grimace (reflex irritability) | No response to stimulation | Weak cry when stimulated | Strong cry when stimulated |
| Activity (tone) | Floppy | Some flexion | Active movement |
| Respiration | No breathing | Slow / irregular breathing | Strong cry |
NLS Guidelines
Inflation breaths:
Ventilation breaths:
Most causes of resuscitation are respiratory problems, instead of cardiac problems. More emphasis is put on optimising 'Breathing', if not managed well, any subsequent interventions (including CPR) would be ineffective.
- To be given if the newborn is not breathing or gasping at birth
- Aim: open collapsed alveoli and establish functional residual capacity
- Administration:
- 2-3 sec of inspiratory time per breath
- 5 is given back-to-back
Ventilation breaths:
- To be given if chest movement is present (indicative of patent airway and delivered volume) but heart rate <100 bpm
- Aim: maintain established lung volume and provide adequate ventilation
- Administration:
- ≤1 sec of inspiratory time per breath
- Regular breaths given 40-60 per min
Most causes of resuscitation are respiratory problems, instead of cardiac problems. More emphasis is put on optimising 'Breathing', if not managed well, any subsequent interventions (including CPR) would be ineffective.
CPR (chest compression to ventilation ratio of 3:1) should only be started if the heart rate is <60 bpm or non-detectable after 30 sec of good quality ventilation
IV adrenaline (1:10,000) 0.2 mL/kg should be given after 30 seconds of effective ventilation and chest compression for 30 sec
Other drugs to consider:
Other drugs to consider:
- Glucose - to reduce the likelihood of hypoglycaemia in prolonged resuscitation
- Isotonic crystalloid / O -ve blood - for suspected blood loss or shock unresponsive to other resuscitative measures
- Sodium bicarbonate - for prolonged unresponsive resuscitation with intracardiac acidosis
The following algorithm only applies if the baby is NOT breathing or gasping at birth.
Discuss stopping resuscitation if there has been no response after 20 minutes and reversible causes have been excluded.