Neonatal Resuscitation

NRP-aligned dosing and equipment

Weight

3.00 kg · 3000 g

GA (weeks)

Equipment

ETT size

3.5

ETT depth (lip)

9.0 cm

Suction catheter

8 Fr

UVC depth

10.0 cm

UAC depth (high)

18.0 cm

Laryngoscope

Miller 1

Vital Signs (term newborn)

• HR: 100–160 bpm (intervene if < 100 or > 180)
• RR: 30–60 breaths/min
• SBP ~ GA in weeks (e.g., 40 wk ≈ 40 mmHg) — MAP ≥ GA
• Temp (axillary): 36.5–37.5 °C
• Glucose: ≥ 45 mg/dL (treat < 40 in first 4h)

Gestational Age Estimates

GA	Avg weight	Length
24 wk	600 g	31 cm
28 wk	1000 g	37 cm
32 wk	1700 g	42 cm
36 wk	2600 g	47 cm
▸ 40 wk	3400 g	51 cm

Ballard exam (physical + neuromuscular score) recommended for accurate GA at delivery.

Emergency Medications

Umbilical Catheter

UVC depth

10.0 cm

UAC high

18.0 cm

UAC low

10.0 cm

Catheter size

5 Fr

• Emergency UVC: insert 2–4 cm until blood return
• Confirm UVC tip at IVC/RA junction (T8–T9 on CXR)
• UAC tip: high T6–T9 or low L3–L4 (avoid renal/mesenteric)

Oxygen Saturation Targets

Time after birth	Preductal SpO₂
1 min	60–65%
2 min	65–70%
3 min	70–75%
4 min	75–80%
5 min	80–85%
10 min	85–95%

Probe on right hand/wrist (preductal). Start FiO₂ 21% term, 21–30% preterm.

APGAR Score

Sign	0	1	2
Appearance	Blue/pale	Body pink, ext blue	All pink
Pulse	Absent	< 100	≥ 100
Grimace	None	Grimace	Cry/cough
Activity	Limp	Some flexion	Active
Respiration	Absent	Slow/irregular	Strong cry

Assess at 1 and 5 min. If < 7 at 5 min, repeat q5 min up to 20 min. APGAR does not guide resuscitation.

Crashing Neonate DDX (THE MISFITS)

T — Trauma (NAT, birth)
H — Heart disease (ductal-dependent CHD) → PGE1
E — Endocrine (CAH, hypoglycemia, thyroid)
M — Metabolic (Na/K/Ca, IEM, hypoglycemia)
I — Inborn errors of metabolism
S — Sepsis (GBS, E. coli, HSV)
F — Formula errors (over/under-dilution)
I — Intestinal catastrophe (NEC, malrotation/volvulus)
T — Toxins (maternal, environmental)
S — Seizures

Empiric workup: D-stick, CBC + cultures, BMP/Ca/Mg, lactate, ammonia, blood gas, CXR, UA, LP. Empiric ceftriaxone or amp + gent + acyclovir, D10 bolus, consider PGE1 if cyanosis unresponsive to O₂.

NRP Quick Reference

• PPV at 40-60 breaths/min if HR < 100 or apneic
• Compressions 3:1 with PPV if HR < 60 after 30s effective PPV
• Start with room air (term) or 21-30% O₂ (preterm)
• Epi 0.02 mg/kg IV/IO (0.06 mg = 0.6 mL of 0.1 mg/mL)
• Volume bolus NS 10 mL/kg (30 mL)
• D10 2 mL/kg for hypoglycemia (6.0 mL)