SWARAJ HOSPITAL & RESEARCH INSTITUTE

Neonatal Resuscitation Algorithm

Heart Rate – Driven Protocol | NRP 2024 Guidelines

BABY BORN

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Dry • Stimulate • Position Airway
Assess Breathing + HR + Tone (0–30 sec)

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✅ Breathing well
HR >100
Good tone

⚠️ Not breathing adequately
OR HR <100

🚨 Apnoeic / Gasping / Floppy

Routine Care
Skin-to-skin
Delayed cord clamping

Initial Steps
(30 sec)

Immediate PPV
Do NOT wait 60 sec

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HR still <100 or not breathing after 30 sec?

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START POSITIVE PRESSURE VENTILATION (by 60 sec)

O₂: 21% term / 30% preterm | Pressure 20–30 cmH₂O | Rate 40–60/min

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AFTER 30 SECONDS OF PPV → CHECK HEART RATE

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HR rising >100

HR >60 but <100 or not rising

HR <60 despite PPV

Continue PPV
Wean as baby breathes

Perform

START CHEST COMPRESSIONS

MR SOPA

3:1 ratio (90 comp : 30 breaths/min)

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HR still <60 after 60 sec of compressions + effective ventilation?

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GIVE ADRENALINE (1:10,000)

IV/IO: 0.01–0.03 mg/kg | ET: 0.05–0.1 mg/kg (temporary)
Repeat q3–5 min if HR <60 | Consider volume expansion (10 mL/kg NS)

🔴 CRITICAL HEART RATE THRESHOLDS – MEMORISE
• <100 at 60 sec → Start PPV
• <60 after 30 sec effective PPV → Start chest compressions
• <60 after 60 sec compressions → Give adrenaline

📋 MR SOPA – Corrective Steps for Failed PPV
Mask adjustment | Reposition airway | Suction (if obstructed)
Open mouth slightly | Pressure increase (+5–10 cmH₂O) | Airway alternative (ETT/LMA)

📊 Continuous monitoring during resuscitation: ECG (3-lead) + Pulse oximetry (right hand/wrist) + Temperature probe (goal 36.5–37.5°C)

Swaraj Hospital & Research Institute – Saving seconds, saving lives.
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