Newborn Resuscitation

The cardiopulmonary resuscitation (CPR) guidelines for newly born babies is different than CPR for other infants, children, and adults. Newborn CPR consists of opening the Airway first, then providing assisted Breathing, and then assisting Circulation through chest compressions (A – B – C). A newborn may need CPR and other emergency care if he or she is:

  • Less than full term (about 40 weeks gestation).

  • Not crying or breathing.

  • Not showing good muscle tone.

Take action in the first minute (this crucial minute is called "The Golden Minute"):

  • Make sure the infant is warm. The newborn should be warmed by being placed near a source of heat. If a source of heat is unavailable:

  • The newborn can be dried and wrapped in towels.

  • Place the newborn skin-to-skin on the mother and place a blanket over both.

To prepare for the A-B-C process of CPR on a newborn:

  • Quickly look at the area where the newborn is located. Help the child only if it appears that the location (a car, street, room, hillside) is safe.

  • Check for response. Gently tap the newborn's foot. If the newborn responds and is breathing normally but is ill or injured, call your local emergency services (911 in U.S.) and wait for help. While waiting, recheck the child frequently.

  • If you are by yourself shout for help. If there is no response and the newborn is not breathing or only gasping, begin the A-B-C process of CPR. In the case of 2 rescuers, 1 rescuer should get help. If there is no response and the newborn is not breathing or only gasping, rescuer 1 begins the A-B-C process and the second calls the local emergency services (911 in U.S.). After calling for emergency services, the second rescuer should return to the newborn as soon as possible to assist with CPR.

ExitCare Image TO PERFORM THE A-B-C PROCESS, TAKE THESE STEPS:

A - Open the Airway

  • Place one hand on the newborn's forehead and push with your palm to tilt the head back.

  • Place the fingers of the other hand under the bony part of the lower jaw to gently bring the chin forward.

  • The newborn's head should be tilted only slightly back to a neutral position. Do not place the newborn's head into a position past a neutral position. A newborn's neck is so flexible that forceful backward tilting might block breathing passages instead of opening them. Except in rare cases, suctioning (including suctioning with a bulb syringe) is NOT recommended for newborns.

  • The newborn should be placed on his or her back or tilted to the side, but not on the stomach.

  • Stimulate the newborn's breathing by massaging and stroking the skin.

ExitCare Image B - Provide assisted Breathing

  • Give rescue breaths. If the newborn is unresponsive, not breathing or only gasping, breathing will need to be assisted. After opening the airway, give 2 rescue breaths. Cover the mouth and nose of the newborn with your mouth. Use 2 small breaths to make the chest rise. The amount of air to fill your cheeks is usually enough to make the newborn's chest rise. Each breath should take 1 second. If the chest does not rise, reposition the head, make a better seal over the newborn's mouth and nose and try a breath again. If unsuccessful with mouth over the newborn's mouth-and-nose, the rescuer(s) can try 2 other rescue breathing methods:

  1. The rescuer(s) can give rescue breaths by placing his or her mouth over the newborn's mouth. If rescue breathing with the mouth over the newborn's mouth, pinch the newborn's nose closed.

  2. The rescuer(s) can give rescue breaths by placing his or her mouth over the newborn's nose. If rescue breathing with the mouth over newborn's nose, the newborn's mouth needs to be closed.

ExitCare Image C - Assist Circulation through chest compressions

  • After 2 breaths, start chest compressions immediately. Begin compressions in the center of the chest, one finger width below an imaginary line drawn between the nipples. Compressions may be done by either of 2 methods:

  1. ExitCare ImageEncircle the newborn's chest with both hands. Place your thumbs over the center of the newborn's chest. Use your thumbs to depress the chest at least 1/3 the total thickness of the chest (about 1.5 inches or 4 cm). This method is recommended for newborns.

  2. Press 2 fingers down on the chest, depressing at least 1/3 the total thickness of the chest (about 1.5 inches or 4 cm). Use this method if you cannot use your thumbs to do compressions (see above). Allow the chest to return completely to its normal position before the next compression. For a newborn, after every 3 compressions, there should be 1 assisted breath. There should be 90 compressions and 30 breaths during each minute of newborn CPR.

  • If there are 2 rescuers, the rescuers should change roles every 2 minutes to maintain quality and rate of chest compressions. The switch should take place as quickly as possible (in less than 5 seconds).

  • Get help. After 2 minutes of CPR, if you are by yourself, call your local emergency services (911 in the U.S.).

  • Continue CPR. Continue with assisted breaths and compressions until the newborn starts breathing normally or ambulance personnel take over care.

CPR is intense and strenuous for the rescuer but can be lifesaving. It is understood that a rescuer can become tired fairly quickly. It is also understood that attempts to do CPR by rescuers give a better chance at saving a life than doing nothing and waiting for ambulance personnel to arrive.

After ambulance personnel arrive, it is important to remain on the scene to give trained rescuers a report of what happened. This is always helpful and an important part of the overall care provided to the newborn.

Almost all communities maintain programs for training the public in the skills of CPR. It is always helpful to know CPR in the unlikely event that your help may be needed.