As babies travel through the birth canal, they can experience a significant lack of oxygen because the supply they receive from the placenta is interrupted during each contraction. This is a natural process, and the vast majority of babies are born with no ill effects. However, for the few that do need help with their breathing after being delivered, different levels of life support are offered. The physicians, midwives and nurses involved will begin with basic care, such as wrapping the newborn and ensuring that they are warm. The team may also take a few moments to dry off the baby. This often stimulates the infant and gives the team a few moments to check them over before official testing takes place.
Professional teams surround and protect each newborn baby
It can be a demanding environment, but the team is made up of skilled professionals who support each other and use their advanced knowledge to care for their newborn patient. If you are keen to be part of this rewarding work, an online NNP program from Baylor University can help you to become qualified. Baylor’s Doctor of Nursing Practice Neonatal Nurse Practitioner course is ranked as the best of its kind in Texas by Nurse Journal and can be completed in 18 months by students who already hold an MSN.
Testing for responses after birth
Once the baby has been made comfortable, it will be more closely assessed using the medical professional’s expertise and training, as well as the Apgar test. This is usually carried out in the first five minutes of a baby being born. Using criteria such as breathing, skin tone and reflexes, it provides an insight into how well a baby is managing outside the womb.
Why does initial life support begin?
A baby that is born in good health will cry within seconds of birth and have a heart rate of between 120 and 150 beats per minute. Most are born with a bluish tinge, but this quickly changes to a pink color. Physicians know that these babies need no immediate life support or additional care unless a change is noted. Babies that have not tolerated their birth as well will also be blue in color, but their heart rate will be noticeably lower, usually less than 100 beats per minute. Some may also be floppy in tone. In these infants, the team might struggle to establish a steady rate of breathing within a few minutes. At this point, they will move on to the initial stage of life support.
Starting the process of life support
Once it is decided that intervention is required, the first step will often be to clear the baby’s airway. This could involve using a towel to wipe away mucus and other secretions from their nose and mouth. Alternatively, doctors may use suction to clear away fluids that are further down the throat. This might be completed manually with a small bulb syringe or through the use of a suction machine. The majority of neonates that require life support at this level usually respond well and need no further care.
Ventilating a baby
In the rare instances where a baby is not appearing to breathe, physicians will move swiftly to the next stage of life support. Known as ventilation, it begins with a team giving the baby air to encourage them to start breathing independently. This will usually be done through a face mask fitted closely to the baby’s skin. They continually look for an improvement in the child’s condition, and if this is not seen very quickly, the team will add oxygen to the air. In the majority of cases, this is enough to encourage independent breathing.
Boosting the circulation and supporting lung function
Getting the lungs of an ill baby aerated is crucial because a lack of oxygen will soon begin to affect their cardiac function. This leaves a newborn in a dangerous situation – their circulation is becoming deficient and therefore does not take enough oxygenated blood to the heart from the lungs. If the neonatal team have tried to aerate the lungs and the baby does not respond, this can lead to a drop in their heart rate and more serious action is required.
Providing additional help with breathing
Babies that do not respond to ventilation will be moved on to the next stage of life support, a treatment known as intubation. Tracheal intubation involves putting a tube into the infant’s mouth or nose and feeding it down into the windpipe. The small tube is then connected to a machine that supplies oxygen. This process opens up the airway and makes it easier for oxygen to get to the lungs. It is a relatively invasive procedure, but it is only done in specific circumstances. Often, this is when the ventilation has been going on for a long time or when the team are also trying to suction away a blockage in the windpipe. It may also be done when physicians decide that they need to provide further life support in the form of chest compressions.
Performing chest compressions and giving medication
Chest compressions are carried out when there is no response to ventilation and there is no heart rate. As infants are so small, it is done carefully, using just two fingers or thumbs to deliver a series of swift compressions at a rate of around 100 per minute. It is uncommon, but if the recovery is not moving quickly enough, doctors can also give an intravenous dose of adrenaline. This usually leads to the baby’s heart rate increasing and their brain being flooded with oxygen. As a result, the baby’s breathing returns to normal.
A rare but vital treatment path
Thankfully, it is very rare that advanced levels of life support are needed by a neonate, and at each stage, they are constantly assessed to ensure that the treatment path is appropriate. However, when a baby does need extra help, a team of medical professionals are on hand to provide the best possible care.