Regional Emergency Medical Advisory Committee of New York City Prehospital Advanced Life Support Protocols Copyright January 1996 (8/96)

543 NEWBORN RESUSCITATION

• MEDICAL CONTROL OPTIONS

For newborns requiring resuscitation whose amniotic fluid does not contain thick meconium:

1. Begin Basic Life Support Newborn Resuscitation procedures.

For newborns requiring resuscitation whose amniotic fluid does contain thick meconium and who are limp, apneic, or pulseless:

1. Begin Basic Life Support Newborn Resuscitation procedures only after the airway has been cleared of thick meconium, as follows:
   • Perform Endotracheal Intubation and directly suction the Endotracheal Tube via a Meconium Aspirator/Adapter while slowly withdrawing the Endotracheal Tube.
   • Repeat this procedure until the Endotracheal Tube is clear of thick meconium, up to 2 more times (total of 3 times).
     
2. NOTE: DO NOT REPLACE THE ENDOTRACHEAL TUBE ONCE THE AIRWAY HAS BEEN CLEARED OF THICK MECONIUM UNLESS THE NEWBORN REMAINS LIMP, APNEIC, OR PULSELESS.
   
   For all newborns requiring resuscitation once Basic Life Support Newborn Resuscitation procedures have begun:
   
3. If CPR has been initiated, and the heart rate is still between 60 and 80 beats per minute and not rapidly increasing after 30 seconds of CPR, perform Endotracheal Intubation.
   
   During transport, or if transport is delayed:
   
4. If abdominal distention occurs, pass a Nasogastric Tube. If unsuccessful, pass an Orogastric Tube.
5. If Endotracheal Intubation has been performed, and the heart rate remains less than 80 beats per minute, administer Epinephrine 0.1 mg/kg (0.1 ml/kg of a 1:1,000 solution), via the Endotracheal Tube.
6. If Epinephrine has been administered, and the heart rate still remains less than 80 beats per minute, the respiratory rate remains less than 30 breaths per minute, or the newborn remains cyanotic or limp, contact Medical Control for implementation of one or more of the following MEDICAL CONTROL OPTIONS:

MEDICAL CONTROL OPTIONS

OPTION A:	Repeat Epinephrine 0.1 mg/kg (0.1 ml/kg of a 1:1,000 solution), via the Endotracheal Tube.
OPTION B:	Administer Naloxone 0.1 mg/kg, via the Endotracheal Tube.
OPTION C:	If transport is delayed or extended, and the newborn is pale and has weak but rapid central pulses, begin an IV/Saline Lock or IO infusion of Normal Saline (0.9 NS) 10 ml/kg, via a large bore IV (18-22 gauge) or IO catheter, or a Saline Lock. Attempt vascular access no more than twice.
OPTION D:	Transportation Decision.

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