Primary resuscitation in the delivery room and drug support
Emergency care for a newborn begins directly in the delivery room. The main goal of the intervention is the prompt restoration of spontaneous breathing and stable hemodynamics.
- Pharmacotherapy: if an adequate heart rate is not restored or severe bradycardia persists, administration of epinephrine (0.1% solution) at a dose of 0.1 mg/kg body weight is indicated. The drug is administered intravenously or intracardiacally.
- Termination criteria: successful procedures are stopped once stable spontaneous breathing is established, cyanosis disappears, and pulse normalizes. If heartbeats are absent for 20 minutes despite full resuscitation efforts, biological death is pronounced.
Following the primary stage, the infant is immediately transferred to the intensive care unit (ward). Mechanical ventilation (MV) is necessary in case of convulsive syndrome, ineffective spontaneous breathing, persistent cyanosis, or shock.
Management of infants with intrauterine growth restriction
Newborns with IUGR require close monitoring from the first minutes due to the risk of asphyxia and meconium aspiration.
- Thermal protection: the infant is immediately placed under a radiant warmer to protect against rapid hypothermia.
- Early feeding: with a stable neurological status and preserved sucking and swallowing reflexes, enteral feeding starts no later than 2 hours of life. Expressed breast milk from a bottle is used.
- Hemostasis: every infant with IUGR, regardless of general condition, is parenterally administered menadione sodium bisulfite (vitamin K) in a volume of 1–2 mg to prevent hemorrhagic disorders.
Nutritional support and basic care
Severe condition requires continuous monitoring in the intensive care unit and individualized nutritional selection:
- Natural feeding: maternal milk is the absolute priority. The method of delivery (breastfeeding, bottle feeding, or nasogastric tube) is determined by the severity of the patient's condition.
- Artificial feeding: if natural feeding is impossible, specialized fermented milk formulas containing live lactoflora are prescribed, which is necessary to stabilize the intestinal microbiota.
- Neuraxial anesthesia in the parturient: the safety of the fetus and mother during NA is ensured exclusively by an anesthesiologist-resuscitologist in a equipped shock room with obligatory venous access and ready infusion solutions.
Neurological consequences of hypoxia and device-based hypothermia
Perinatal hypoxia leads to ischemic and hemorrhagic CNS injuries of varying severity:
| Severity | Clinical manifestations | Notes |
|---|---|---|
| Mild | Short-term hyper-excitability | Symptoms are mild |
| Moderate | Muscular dystonia, depression of unconditioned reflexes, regurgitation, fontanelle bulging, Graefe's sign, nystagmus, clonic seizures | Symptoms of depression and hypertension predominate |
| Severe | Apgar score ≤ 3 points, comatose state, tonic seizures, focal symptoms, shock | Consequence of cerebral edema and hemorrhage |
For neuroprotection in moderate and severe forms of asphyxia, craniocerebral hypothermia is used. The method is strictly contraindicated in extreme prematurity, infant body weight less than 1800 grams, and extensive intracranial hemorrhages.
The "Three NOs" rule for craniocerebral hypothermia: NOT full-term, NOT 1800 g, NOT avoiding massive intracranial hemorrhage — cooling is prohibited.
Class and exam questions
When is it necessary to start enteral nutrition for a newborn with IUGR?
In a stable condition with preserved reflexes, feeding with expressed breast milk is started no later than 2 hours from birth.
Which drug and at what dose is indicated for the ineffectiveness of chest compressions and bradycardia in a newborn?
A 0.1% solution of epinephrine (adrenaline) is administered at a rate of 0.1 mg/kg body weight intravenously or intracardiacally.
What are the absolute limitations for performing craniocerebral hypothermia?
The procedure is contraindicated in premature infants, children with a body weight of less than 1800 g, and patients with massive intracranial hemorrhages.
What else to study on this topic
- Features of using fermented milk formulas with lactoflora in the absence of lactation
- Technical standards for venous access and infusion preparation before performing neuraxial analgesia
- Clinical picture of the setting-sun sign and Graefe's sign in hypertensive syndrome
- Protocol for transporting a newborn on mechanical ventilation from the delivery room to the ICU
Master the entire topic in the Pediatrics course
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- Complete study guide on "Neonatal Intensive Care" and another 3,738 subject pages
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Other topics in «Chapter 2. Neonatology»
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