Protocol 2-616 - Newly Born

CMH EMS & MIH Protocols

In general, this protocol's scope covers management of the baby/babies after delivery and the point of cutting the umbilical cord. Before cutting the cord refer to Protocol 2-242 - Childbirth / Labor.

EMD:

• No specific protocol.

EMR:

• Mother still in labor: Refer to Protocol 2-242 - Childbirth / Labor.
• Confirm ABCs.
• RESUSCITATION is required:
• Clamp and cut umbilical cord immediately.
• Establish and maintain airway.
• Suction thoroughly.
• HR less than 60: Chest compressions at 120 per minute. Ratio of 3:1. Use BVM on room air unless you suspect hypoxic event.
• HR less than 100: BVM with room air at 40-60 breaths per minute. Remember, newborn tidal volume may be 25 ml or less.
• If no improvement after 90 seconds: BVM with 100% Oxygen.
• Apply Cardiac Monitor limb leads.
• Resuscitation is NOT required:
• Wait 1 minute to clamp and cord.
• Consider Oxygen to maintain pre-ductal SpO2 according to chart found on Protocol 2-616-66 - Targeted Pre-Ductal SpO2.
• Maintain warmth of the infant.
• Suction mouth, then nose, with bulb syringe.
• Dry and STIMULATE with a clean towel.
• Obtain APGAR score at 1 minute and 5 minutes after delivery.
• Refer to Protocol 2-616-33 - APGAR Scoring System.

EMT:

• Ensure completion of applicable items above.
• Blood sugar less than 30 mg/dl: Refer to Protocol 2-572 - Hypoglycemia for treatment.

AEMT:

• Ensure completion of applicable items above.
• If RESUSCITATION is required:
• Consider IV NS/LR 10 ml/kg over 10 min.
• Click "calculate" to get dose.
• Consider Narcan 0.1 mg/kg IV/IN/IM/SQ/ET.
• Click "calculate" to get dose.

RN:

• Ensure completion of all applicable items above.
• If RESUSCITATION is required:
• Consider IO NS/LR fluid bolus if IV in AEMT section unsuccessful.
• HR remains less than 80 despite BVM and chest compressions:
• Epinephrine 1:10,000 0.02 mg/kg IV/IO followed by 4 ml NS flush.
• Click "calculate" to get dose.
• No response to first Epi: Epinephrine 1:10,000 0.1 mg/kg (1 ml/kg) ET followed by 4 breaths.
• Click "calculate" to get dose.

Medic:

• Ensure completion of all applicable items above.
• If RESUSCITATION is required:
• Meconium present: Laryngoscopy and Deep Suction trachea with ET Tube. After intubation, prolonged positive pressure ventilation at 40-60 breaths per minute.
• No response after stimulation, BVM, compressions, and deep suctioning: INTUBATE.

• Gestational age	ET Size	Depth
  Less than 28 weeks	2.5	6-7 cm
  28-34 weeks	3.0	7-8 cm
  34-38 weeks	3.5	8-9 cm
  Greater than 38 weeks	4.0	9-10 cm

CP:

• Ensure completion of all applicable items above.
• Refer to MIH Protocol 4-333 - Chronic OB/GYN Management.

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Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.