Initial assessment

A: Patent, no meconium

B: Occasional gasps, poor chest rise

C: Pale colour, blue feet, heart rate slow

D: Poor tone, some responsiveness

E: Cold and wet

Okay, okay… for a newborn we don’t really do an A to E usually. We think colour, tone, breathing effort, heart rate – but under stress you might forget any NLS if you haven’t been trained. If you haven’t done NLS: rely on what you know. As we’ll see there are some important caveats.

In our simulation, the Consultant took charge accompanied by senior nurses. The neonatal stack was quickly sought, a transwarmer was applied and wet towels removed. The baby was slow to improve despite stimulation, effective inflation breaths and ventilation breaths. The heart rate remained above 60bpm throughout, then at 10 minutes that wonderful all important cry was heard (easily the most beautiful noise in neonatology!)

The Debrief

We stopped the sim and reflected on the learning points raised, particularly the importance of…

Staying calm under pressure

Staying dry under towels

Staying warm under more towels

Staying focused on the airway

Staying off the chest at first

Oh, and calling for help early!

So, for those uninitiated regarding newborn resuscitation, let’s review the basics…