Management of Birth Asphyxia in Newborns

Initial Ventilation Settings

For a 3kg newborn with birth asphyxia not maintaining oxygen saturation on hood, immediate intubation and mechanical ventilation should be initiated with initial settings of PIP 20-25 cmH2O, PEEP 5 cmH2O, rate 40-60 breaths/min, and starting with 21-30% oxygen titrated by pulse oximetry, as recommended by the American Academy of Pediatrics 1, 2
Initial ventilator settings should include Peak Inspiratory Pressure (PIP) of 20-25 cmH2O, as suggested by the American Academy of Pediatrics 4, 3
Positive End-Expiratory Pressure (PEEP) should be set at 5 cmH2O, according to the American Academy of Pediatrics 4
Respiratory Rate should be set at 40-60 breaths/minute, as recommended by the American Academy of Pediatrics 5
FiO2 should start with 21-30% and be titrated based on pulse oximetry, as suggested by the American Heart Association 1, 2

Pulse oximeter should be attached to the right upper extremity to guide oxygen titration, as recommended by the American Heart Association 6, 7
Target oxygen saturation levels should be similar to those of healthy term newborns, initially 60-65% at birth, gradually increasing to 85-95% by 10 minutes, according to the American Academy of Pediatrics 6
Oxygen concentration should be carefully titrated to avoid both hyperoxemia and hypoxemia, as suggested by the American Academy of Pediatrics 2, 5

Heart rate should be monitored continuously, as it is the most sensitive indicator of resuscitation efficacy, according to the American Heart Association 2, 5
If heart rate remains below 60 bpm despite effective ventilation, chest compressions should be initiated using the 2-thumb, hands-encircling-the-chest method, as recommended by the American Heart Association 1
A 3:1 compression-to-ventilation ratio should be used, as suggested by the American Heart Association 1, 6

If heart rate remains below 60 bpm despite effective ventilation and chest compressions, epinephrine 0.01-0.03 mg/kg IV should be administered, as recommended by the American Heart Association 6, 7
Volume expansion with normal saline 10 ml/kg should be considered if signs of hypovolemia are present, according to the American Heart Association 6

Exhaled CO2 detection should be used to confirm endotracheal tube placement, as recommended by the American Academy of Pediatrics 3
Vital signs, including heart rate, oxygen saturation, and blood pressure, should be monitored continuously, according to the American Academy of Pediatrics 2, 5
Neurological status should be assessed frequently, as suggested by the American Heart Association 6

Therapeutic hypothermia should be considered for moderate to severe hypoxic-ischemic encephalopathy, as recommended by the American Heart Association 6, 7
Cooling should be initiated within 6 hours of birth under clearly defined protocols, according to the American Heart Association 6
Multidisciplinary care should be maintained in a neonatal intensive care unit, as suggested by the American Heart Association 6

100% oxygen should not be used for initial resuscitation, as it provides no advantage over air and may increase oxidative injury, according to the American Heart Association 1, 2
Excessive ventilation should be avoided, as it can lead to lung injury and decreased cerebral blood flow, as suggested by the American Academy of Pediatrics 4, 3
Delays in initiating therapeutic hypothermia should be avoided when indicated, according to the American Heart Association 6
Color should not be relied on as an indicator of oxygenation; pulse oximetry should be used instead, as recommended by the American Academy of Pediatrics 2, 5