The critically ill neonate in the emergency department

Recognition of the high-risk mother and fetus is an essential component of resuscitation if it is to be organized, accurate, and successful. Although many high-risk factors put the neonate in jeopardy, the first responder or ED physician can plan the initial approach to resuscitation by knowing the answer to three questions: (1) Is there particulate meconium in the amniotic fluid? (2) Is the fetus/baby premature? and (3) Is a multiple gestation pregnancy expected? Although the ABCs (airway, breathing, circulation, chemical) of resuscitation adequately describe the parameters essential for adequate resuscitation, they do not relate to the actions necessary to accomplish this feat; therefore, it is important for participants in neonatal resuscitation to remember the acronym SOS--suction, oxygen, stimulation. Even infants with moderate depression (occasional respiratory effort) will generally respond to brief suctioning of the airway, 100% oxygen, and vigorous stimulation. If SOS is ineffective, PPV must be administered without hesitation. Resuscitation of the newborn is not a simple procedure, but rather a dynamic process involving continuous evaluation, action, and reassessment before, during, and after the actual resuscitation. A specially trained resuscitation team of physician, nurse, and respiratory therapist interacting in a dynamic evaluation approach is ideal but not practical for most community hospitals. Each hospital must develop its own protocol and train and maintain its resuscitation personnel. If each member of the team is prepared to take over in the absence of the others, neonatal resuscitation will remain fast, organized, and accurate.