Of the approximately 3.5 million births in the United States each year, 10% require resuscitation in the delivery room (Table 40-18: Events Associated with Neonatal Depression at Birth). Factors that contribute to depression of the newborn include medications used during labor and delivery (anesthetic agents), birth trauma, and birth asphyxia (hypoxia and hypercapnia with metabolic acidosis).
- Resuscitation. The delivery room must be prepared for adequate and prompt treatment of severe neonatal depression at birth (Table 40-19: Resuscitation Equipment in the Delivery Room and Fig. 40-3: Algorithm for neonatal resuscitation).
- Evaluation and Treatment. The initial appraisal of the newborn starts with determining the answers to the following three questions: (1) Is the newborn the result of a term gestation? (2) Is the newborn crying or breathing vigorously? (3) Does the newborn have good muscle tone? If the answer to any of these questions is “No,” then further resuscitation should be provided following specific steps in sequence (Table 40-20: Steps in Newborn Resuscitation).
- The APGAR Score
(Table 40-21: Calculation of the Apgar Score)
- Diagnostic Procedures. After the neonate is resuscitated and stabilized, it is important to rule out choanal atresia (occlude each nostril) and esophageal atresia (pass suction catheter into the stomach and aspirate gastric contents).