Neonates are newborns who are less than a month old. It's important to note that there are some significant differences between resuscitating neonates compared to infants.
As with infants, it's most common for the respiratory drive or lack of oxygen to contribute to the neonate's unresponsiveness versus a cardiac-driven event. This is important as it reflects how we perform rescue breaths and CPR. The following CPR instructions are for respiratory distress.
Pro Tip #1: The rescue mask for neonates is extremely small. It's important to have rescue masks to fit every size patient, as an adult mask could prove useless when trying to resuscitate a newborn.
How to Provide Care
After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin to assess whether or not the newborn is responsive.
If you don't get an initial response and you can see that the infant still isn't breathing normally, place your hand on his or her forehead and tap on the bottom of the newborn's feet. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions.
- Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
- Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse.
Pro Tip #2: If the newborn's pulse is 100 beats per minute or less but not less than 60, perform rescue breathing – one rescue breath every two to three seconds.
If the newborn's pulse is less than 60, begin to perform full neonatal CPR – three chest compressions followed by one rescue breath.
CPR Technique for Neonates
- Just as you would for infants (the landmarks are the same), draw an imaginary line across the newborn's nipples and place two fingers on the lower part of the sternum in the center of the infant's chest. Your fingers should be perpendicular to the baby's chest, meaning your knuckles are directly above your fingers during compressions.
- Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on neonates, use only your fingers to supply the force for the chest compressions, and count as you perform them.
- Conduct compressions that go to a depth of 1/3 of the newborn's chest cavity, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
- Perform three chest compressions.
- Grab the rescue mask and seal it over the victim's face and nose.
- Breathe once into the rescue mask and wait for the chest to rise and fall.
- Continue to perform three chest compressions to one rescue breath for two minutes then reassess for vital signs. If the neonate's pulse is still slow or there is no pulse, continue CPR until help arrives, an AED arrives, or the victim is responding positively and breathing normally.
Pro Tip #3: Although most situations involving an unresponsive neonate will be due to a respiratory problem, remember that there is a difference in how we resuscitate an unresponsive newborn who has had a cardiac-related event that led to their current condition. If their condition was due to a congenital heart defect or cardiac arrest, perform 15 compressions to two rescue breaths and repeat.
Performing Neonate CPR in a Two-Responder Setting
This two-responder scenario is more likely to be found in a clinical or professional health setting. It allows the responders to incorporate things like high-flow oxygen with a bag valve mask and the use of circumferential thumb compressions. This is much more efficient when performing just three compressions to every breath, as one responder can handle the bag while the other performs the compressions.
A Word About Vital Signs (By Age)
Assessing a patient's vital signs is a crucial first step in providing care. Therefore, it's important to know what range is normal when it comes to pulse rates and respirations.
For Adults (12 years and older)
Pulse rate – 60 to 100 beats per minute
Respirations – 12 to 20 breaths per minute
For Children (1 year to 12 years old)
Pulse rate – 80 to 100 beats per minute
Respirations – 15 to 30 breaths per minute
For Infants (1 month to 12 months old)
Pulse rate – 100 to 140 beats per minute
Respirations – 25 to 50 breaths per minute
For Neonates (full term to 30 days)
Pulse rate – 120 to 160 beats per minute
Respirations – 40 to 60 breaths per minute