How I Do it? - Resuscitation of normal new-born by Dr. Mukul Tiwari

What shall I do when I am called to an Obstetric Unit to attend a normal newborn?


Dr Mukul Tiwari, MD, DCH, FIAP

Consultant Pediatrician & Neonatologist,

President Adolescent Chapter MP, Indian Academy of Pediatrics

Member Web Committee Adolescent Chapter, IAP

Exec Member: Disaster Management Group &  Medico-legal Group IAP


Author “A to Z Baby care" (English & Hindi Editions)

Central working Council Member, IMA


Address: Apex Hospital, University Road, Gwalior, PC 474011

Phone: 0751-2340924, 2340910. M-09827383008

Introduction: Neonatal Birth asphyxia accounts for about 19% of the 5 million neonatal deaths which occur each year world wide. It also accounts for a large no of mentally and physically subnormal children. For most of these newborns resuscitation was not available. Therefore outcome of thousands of newborns per year may be improved if neonatal care can be improved. About 90% babies require no help to establish normal breathing .Approximately 10% of newborns require some kind of assistance to begin breathing at birth; about 1 % need vigorous resuscitation to survive.

As soon as I arrive in Obstetrician’s set up I will first check that the delivery room has all the necessary equipments to successfully resuscitate a newborn of any gestational age. The equipment should include a radiant warmer, warmed blankets, a source of oxygen, Neonatal Ambu Bag, Neonatal Laryngoscope, Endotracheal tubes ,a source of regulated suction, instruments and supplies for establishing intravenous access, trays equipped for emergency procedures, and drugs that may be useful in resuscitation like epinephrine and Soda Bicarb. 

While the baby is coming out of delivery room or operation theatre I can do a quick assessment. A term infant with clear amniotic fluid, a lusty cry, adequate respiratory effort and good muscle tone is enough to put me at ease without attempting any frantic efforts.  I will proceed in the following manner then take the following steps-    

·         Put baby supine under a radiant warmer. If baby reception area is not having a Radiant Warmer then a heater may be used judiciously.

·         Position the baby’s head in slight hyperextension (sniffing position) to create a good air passage.

·         Clear the airway of secretions with a gentle suction of first mouth then nostrils. It is important to first suction mouth. Suction is not necessary if there are minimal or no secretions.

·         Dry the infant with a pre-warmed sterilized cloth. Some babies come out full of secretions and you need extra supply of cloth for them. Some babies have a lot of vernix. Don’t try to peel off all the vernix violently. Pre-sterilized cotton dipped in pre-sterilized oil will clean the vernix smoothly.

·         Clamp and cut the umbilical cord .Check the stump afterwards for bleeding because clamps may be defective and thread tie may come loose.

·         Drying and suctioning of baby will produce enough stimulation for baby to cry spontaneously. If there is meconium baby’s throat and nose should be suctioned thoroughly followed by suctioning of trachea with an infant feeding tube with the help of a laryngoscope. This should be followed by a gastric wash with normal saline.

·         Baby may be then clothed and kept for a brief period of observation after which the baby may be sent to the mother’s room. If it is a normal delivery baby may be kept on the mother’s chest or side to keep her warm. If it is a Cesarean operation delivery and mother will take time to come out of the OT the baby may be kept a little longer in the baby reception unit under strict supervision of a competent attendant or sent to the mother’s room where relative ladies, probably her Grandma, will hold the baby and take care of it.   

Newborn infants who need extensive resuscitation should be rapidly identified. After initial stabilization (provide warmth, position, clear the airway, dry, stimulate, and reposition) they need positive pressure ventilation, chest compressions, and medications. Below is the algorithm for the steps of immediate post partum newborn care




Click here to view other articles in this section