Neonatal Resuscitation Algorithm—2015 Update

This figure conveys the Neonatal Resuscitation Algorithm, which was updated in 2015. It includes a flowchart as well as an inset table at the bottom right. At the top of the flowchart, a green box contains text that states: Antenatal counseling. Team briefing and equipment check.” An arrow points downward to a white box containing the word “Birth.” A red bracket and the words “1 minute” indicate that “Birth” is the beginning of “the Golden Minute” for completing the initial steps to avoid unnecessary delay in initiation of ventilation. An arrow points downward to a red hexagon. It contains several questions: “Term gestation? Good tone? Breathing or crying?” If the answers are “Yes,” an arrow points to the right to a green box. It states: “Infant stays with mother for routine care: warm and maintain normal temperature, position airway, clear secretions if needed, dry. Ongoing evaluation.” If the answers are “No,” follow the arrow downward to a green box containing the following instructions: “Warm and maintain normal temperature, position airway, clear secretions if needed, dry, stimulate.” From here, an arrow points down to another hexagon, which asks: “Apnea or gasping? Heart rate below 100 beats per minute?” If the answers are “Yes,” follow the arrow downward to a green box that says, “PPV. S P O2 monitor. Consider ECG monitor.” (Note that “S P O2” stands for “peripheral capillary oxygen saturation.”) This pathway continues, as will be described shortly. If the answers are “No,” follow the arrow to the right to another hexagon that asks, “Labored breathing or persistent cyanosis?” If “Yes,” an arrow leads to a green box that says, “Position and clear airway. S P O2 monitor. Supplementary O2 as needed. Consider C-pap.” (There is not a corresponding box in the flowchart if the answers are “No.”) The red bracket mentioned earlier shows that this marks the end of “the Golden Minute.” However, the flowchart continues. This green box points to yet another green box that says, “Postresuscitation care. Team debriefing.” This particular pathway ends. However, another pathway continues. Returning to the green box that says, “PPV. S P O2 monitor. Consider ECG monitor,” follow the arrow downward to a red hexagon that asks, “Heart rate below 100 beats per minute?” If the answer is “No,” an arrow points to the right to the green box that says, “Postresuscitation care. Team debriefing.” That’s where this pathway ends. But if the answer is “Yes,” an arrow leads down to a green box that says, “Check chest movement. Ventilation corrective steps if needed. E.T.T. or laryngeal mask if needed.” This path proceeds down to another red hexagon that asks, “Heart rate below 60 beats per minute?” If the answer is “No,” an arrow points back to the prior hexagon with the same question. But if the answer is “Yes,” an arrow leads down to a blue box that states: “Intubate in not already done. Chest compressions. Coordinate with PPV. 100% O2. ECG monitor. Consider emergency UVC.” This leads to another hexagon that again asks, “Heart rate below 60 beats per minute?” If the answer is “Yes,” proceed to the green box that says, “IV epinephrine if heart rate is persistently below 60 beats per minute. Consider hypovolemia. Consider pneumothorax.” Then circle back to the hexagon above that asks, “Heart rate below 60 beats per minute?” The inset table is titled “Targeted Preductal S P O2.” It has two columns of information. The number of minutes is listed on the left, and the corresponding percentage is on the right. For 1 minute, the target is 60 to 65%. For 2 minutes, 65 to 70%. For 3 minutes, 70 to 75%. For 4 minutes, 75 to 80%. For 5 minutes, 80 to 85%. For 10 minutes, 85 to 95%. This figure is copyright 2015 by the American Heart Association.