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What Do You Mean by Neonatal Resuscitation?

What does newborn resuscitation mean?

Rapid and effective neonatal resuscitation within seconds after birth is essential for the baby’s survival under these conditions.

Neonatal resuscitation is a procedure to stimulate and help newborn babies breathe if they do not start breathing spontaneously after birth. Some babies require only basic measures such as warmth, airway clearance, and gentle stimulation, but some may require cardiopulmonary resuscitation (CPR) with assisted ventilation and chest compressions.

Approximately 10% of all newborns in the United States require some assistance during the transition from fetus to newborn.

Why is neonatal resuscitation required?

Oxygen deprivation (asphyxia) during delivery because of compression of the umbilical cord, and extreme prematurity are two major complications of pregnancy that require intervention with neonatal resuscitation. Rapid and effective neonatal resuscitation within seconds after birth is essential for the baby’s survival under these conditions.

Neonatal resuscitation is performed to:

  • Provide oxygen
  • Stimulate respiration
  • Stimulate cardiac function and adequate blood flow
  • Maintain core temperature
  • Maintain blood glucose levels

Several systemic changes take place before, during, and immediately after birth, which enables a baby to breathe and survive outside the uterus. If these systemic changes are delayed or inefficient due to prematurity or illness, neonatal resuscitation becomes necessary.

Two major systemic changes during fetal to neonatal transition are:

Respiratory adaptation

Fetal lungs are nonfunctional and the oxygen/carbon dioxide gas exchange takes place in the placenta. The fetal lungs, and the air sacs (alveoli) which develop after 20 weeks of gestation, are filled with fluid secreted by the inner lining of the lungs (pulmonary epithelium).

The change of position of the fetus before birth and the contractions during labor help expel some of the fluid in the lungs. Hormonal secretions during birth stop the secretion of fluid in the lungs and promote reabsorption and drainage of the remaining fluid.

A substance known as surfactant secreted in the lungs reduces the surface tension in the liquid/air interface in the alveoli and prevents them from collapsing with the removal of the fluid. The negative pressure created in the lungs with the elimination of fluid enables the baby to draw their first breath.

Sensors are known as mechanoreceptors sense respiratory muscle movements, and chemoreceptors that sense levels of oxygen, carbon dioxide, and pH levels activate. Feedback from the receptors stimulates the respiratory center in the brain, which drives and regulates continued respiration.

Cardiovascular adaptation

The fetus has a right-to-left blood circulation which starts changing to left-to-right, immediately after birth, when the baby draws its first breath. The fetal circulation is facilitated by two shunts in the heart and a shunt in the vein that brings oxygenated blood from the placenta. All three shunts close shortly after birth and fuse gradually.

  • Foramen ovale: A small opening in the wall (septum) between the right and left chambers (atria) of the heart.
  • Ductus arteriosus: A connection between the pulmonary artery and the descending aorta.
  • Ductus venosus: A connection between the liver’s portal vein and the central vein, inferior vena cava.

In fetal circulation, oxygen-rich blood from the placenta flows through the umbilical vein to the fetus. Some of the blood perfuses the liver, but most of it bypasses the liver and flows into the inferior vena cava through the ductus venosus and into the right upper chamber (atrium) of the heart. 

The blood then flows into the left atrium through the foramen ovale and into the left ventricle. Most of the blood flows through the aorta and the ductus arteriosus to the rest of the body, bypassing the lungs. The pulmonary vessels in the fetus are constricted and the lungs get a small amount of blood required for their development.

When the newborn takes the first breath, the oxygenation of the blood results in dilation of pulmonary vessels, and blood flow between the heart and the lungs increases. The pressure in the left heart chambers closes the one-way valves in the two heart shunts, the umbilical cord clamping closes the ductus venosus, thus establishing left-to-right circulation.

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