Doctors resuscitate babies with asphyxia by following a carefully structured sequence of steps aimed at quickly restoring breathing, circulation, and oxygen delivery to vital organs. The process begins immediately after birth when a baby shows signs of difficulty breathing or a low heart rate due to insufficient oxygen (asphyxia). The goal is to open the airway, support breathing, maintain circulation, and, if necessary, administer medications to stimulate the heart.
First, the airway must be opened. The baby is placed on their back with the head in a neutral position—slightly extended but not overextended or flexed—to ensure the airway is clear. If the baby’s airway is blocked by mucus, blood, or meconium (the baby’s first stool), gentle suctioning is performed using a soft catheter to clear the throat and mouth. Care is taken not to suction too deeply or aggressively, as this can cause further complications like apnea (cessation of breathing) or a slowed heart rate by stimulating the vagus nerve. Suctioning the nose is avoided before clearing the mouth to prevent the baby from gasping and inhaling secretions.
Once the airway is open, doctors or neonatal resuscitators provide positive pressure ventilation (PPV) using a mask and bag or, if necessary, endotracheal intubation (inserting a tube into the windpipe). This helps the baby start breathing by delivering air or oxygen into the lungs. Ventilation is the most critical step because a good heart rate depends on adequate oxygenation. The heart rate is closely monitored; a rate above 100 beats per minute indicates effective ventilation.
If the heart rate remains below 60 beats per minute despite effective ventilation for about one minute, chest compressions are started to support circulation. Compressions are given in coordination with ventilation to improve blood flow and oxygen delivery to the brain and other organs. The ratio of compressions to breaths is typically 3:1 in newborn resuscitation.
If the heart rate still does not improve, medications such as epinephrine (adrenaline) may be administered intravenously or through the endotracheal tube to stimulate the heart. Naloxone may be given if opioid exposure is suspected as a cause of respiratory depression.
Throughout this process, the use of oxygen is carefully controlled. Starting with room air (21% oxygen) is preferred because high concentrations of oxygen can increase the risk of brain injury. Supplemental oxygen is only increased if the baby’s condition does not improve with room air ventilation.
After successful resuscitation, the baby is closely monitored for signs of organ dysfunction caused by the initial oxygen deprivation. Severe asphyxia can lead to complications affecting the brain, kidneys, intestines, and other organs. Post-resuscitation care may include therapeutic hypothermia, a treatment that cools the baby’s body to slow brain metabolism and reduce injury. Supportive treatments such as mechanical ventilation, fluid management, seizure control, and nutritional support are provided as needed.
The entire resuscitation and post-resuscitation process requires a skilled, multidisciplinary team working quickly and efficiently. Early recognition of asphyxia, prompt airway management, effective ventilation, and circulation support are vital to improving outcomes and reducing the risk of long-term neurological damage.
In summary, resuscitating a baby with asphyxia involves:
– Positioning the baby to open the airway and clearing any obstructions gently.
– Providing positive pressure ventilation to initiate breathing.
– Monitoring heart rate to assess effectiveness.
– Starting chest compressions if the heart rate remains low.
– Administering medications like epinephrine if necessary.
– Using oxygen cautiously, starting with room air.
– Providing advanced post-resuscitation care including therapeutic hypothermia and organ support.
This stepwise approach maximizes the chances of survival and healthy development for babies who suffer oxygen deprivation at birth.