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Health Conditions Discover Plan Connect. Medically reviewed by Michael Weber, M. During birth, babies continue to fill their oxygen needs through the umbilical cord and placenta. When your baby is delivered , his lungs are still filled with amniotic fluid thanks to all of that practice breathing in utero which, by the way, stops when you go into labor.
The fluid then begins to drain from his lungs and is replaced by oxygen, and the lungs begin to work all on their own just like yours. By about week 28 of pregnancy, the lungs have developed enough that premature babies can breathe on their own — although the lungs and circulatory system still need some more time to mature.
Around week 37, the lungs have developed more fully, and they'll keep on growing and fine-tuning until your little one is at least 8 years old. The lungs will start on one particularly important job at around month 6 of pregnancy: making surfactant, which allows them to inflate and deflate.
This substance and alveoli tiny air sacs at the end of airways continue to develop right up until your due date. Artificial surfactant can help babies born extremely preterm before 28 weeks , along with breathing assistance from a ventilator, CPAP machine or small breathing tubes placed in those teeny-tiny nostrils. Some babies born before 36 weeks and most babies born before week 32 may also need some breathing support. Luckily, these medical advances and a stay in neonatal intensive care unit NICU can treat respiratory problems and greatly help even the teeniest preemies.
What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy. The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff.
This prevents rapid heat loss due to evaporation, even in a warm room. There is no need to smack newborn infants to get them to breathe. Never shake an infant. If the infant does not cry or breathe well in response to drying and stimulation, the umbilical cord must be cut and clamped immediately and the infant must be moved to the resuscitation area.
Infants who are active and breathe well can stay with their mother. It is best to delay clamping their umbilical cord for 2 to 3 minutes if the infant does not need resuscitation. Then the infant should be placed in the kangaroo mother care position to keep warm. Infants who breathe well should not be routinely suctioned as this is not necessary and suctioning sometimes causes apnoea.
Infants born by Caesarean section also need not be routinely suctioned. If the infant fails to respond to the stimulation of drying, then the infant must be actively resuscitated.
The most experienced person, irrespective of rank, should resuscitate the infant. However, all staff who conduct deliveries must be able to resuscitate infants. It is very helpful to have an assistant during resuscitation. Stand at the head of the infant where it is easier to carry out the steps needed in resuscitation. There are 4 main steps in the basic resuscitation of a newborn infant.
They can be easily remembered by thinking of the first 4 letters of the alphabet, i. Therefore the steps in neonatal resuscitation are:. If opening the airway fails to start breathing, the infant needs ventilation. Do not waste time by giving oxygen, without also applying ventilation, if the infant does not breathe.
Most infants who breathe well will have a good heart rate and soon become centrally pink. Free-flow mask oxygen alone, without ventilation, is only indicated in the few infants who breathe well with a good heart rate but remain centrally cyanosed. Even in infants who are warm and breathe well, peripheral cyanosis may take up to 10 minutes to resolve. Ventilation is usually given with room air. However sometimes it may be necessary to give supplementary oxygen until good breathing efforts and heart rate are established.
Set the flow meter at 5 litres per minute. Added oxygen can usually be stopped once the infant is centrally pink and the heart rate normal. It is very useful to have a blender and pulse oximeter so that the amount of oxygen can be monitored and controlled. Remember that a self-inflating bag and mask will not deliver oxygen unless the bag is squeezed. A T-piece infant resuscitator is a very efficient method of ventilating a newborn infant by face mask or endotracheal tube.
Oxygen : If possibly infants should be resuscitated in room air only without additional oxygen. Only if the heart rate does not increase to beats per minute or if central cyanosis remains despite adequate ventilation should oxygen be given.
Oxygen should be reduced then stopped as soon as possible. Stop ventilation once the infant is pink and breathing well with a heart rate above beats per second. If the heart rate remains below 60 beats per minute in spite of effective ventilation for one minute seconds, chest compressions are needed. A good heart rate is the best indicator of adequate ventilation. Apply chest compressions external cardiac massage at a rate of about 90 times a minute. Usually three chest compressions are followed by one ventilation a breath.
One or both hands can be used to give chest compressions. Chest compressions are indicated if the heart rate is less than 60 beats per minute after one minute of adequate ventilation. When the heart rate reaches above 60 beats per minute, chest compressions can be stopped and the heart rate carefully monitored. If the heart rate has not increased above 60 beats per minute, give adrenaline epinephrine to stimulate the heart.
Adrenaline should be given intravenously, usually into the umbilical vein or a peripheral line. Adrenaline stimulates the myocardium and increases the heart rate. One ml of the diluted solution can then be given to term infants and 0. Adrenaline is important if the heart rate remains slow or if no heart beat can be detected.
The dose can be repeated every 3 to 5 minutes if the heart rate does not increase to above 60 beats per minute. Do not give adrenaline subcutaneously or by intramuscular injection. Adrenaline is indicated if the heart rate is less than 60 beats per minute after one minute of chest compressions. If the infant has a good heart rate and is centrally pink, but still does not breathe, consider giving naloxone Narcan if the mother has received an opiate analgesic pethidine or morphine in the 4 hours before delivery.
Naloxone 0. Naloxone will not help resuscitate an infant if the mother has not received an opiate analgesic during labour, or has only received a general anaesthetic, barbiturates or other sedatives. Naloxone is not a general respiratory stimulant.
Never give naloxone before providing adequate ventilation. With experience and further training, additional medication e. The 4 steps in resuscitation are followed step by step until the 3 most important vital signs of the Apgar score have returned to normal:. The Apgar scores at 1 and 5 minutes are not a good indicator of the likelihood of hypoxic brain damage or the possibility of an unsuccessful resuscitation. If the Apgar score remains low after 5 minutes, efforts at resuscitation must be continued.
It is important to keep repeating the Apgar score every 5 minutes until the score is normal or resuscitation is abandoned. If the infant has not started to breathe, or only gives occasional gasps by 20 minutes, the chance of death or brain damage is extremely high.
The exception is when the infant is sedated by maternal drugs. It is preferable if an experienced person decides when to abandon further attempts at resuscitation. Resuscitation can also be stopped if there are no signs of life no heart beat after 10 minutes.
Infants that start breathing as soon as mask and bag ventilation is provided can be observed with their mothers. However infants who require more prolonged ventilation must be carefully observed in the newborn nursery for at least 4 hours after delivery. Their temperature, pulse and respiratory rate, colour and activity should be recorded and their blood glucose concentration checked.
Keep these infants warm and provide fluid and energy either intravenously or orally. Usually these infants are observed in a closed incubator. Developing babies need oxygen beginning early in pregnancy. Instead, the umbilical cord provides the baby with oxygen until the first breath. Lung development begins early in pregnancy, but is not complete until the third trimester. Between 24—36 weeks of pregnancy, the lungs begin developing alveoli — the tiny lung sacs that fill with oxygen.
Until these sacs are fully developed, a baby may have difficulty breathing on its own outside of the womb. Women giving birth sometimes worry about how their babies will breathe, especially as the baby travels down the narrow confines of the birth canal. The umbilical cord continues to supply a baby with oxygen until after it is born.
The umbilical cord connects to the placenta, which is connected to the uterus. Both structures house many blood vessels, and continue to grow and develop throughout pregnancy.
Together, the umbilical cord and placenta deliver nutrients from the mother to the baby. They also provide the baby with the oxygen-rich blood necessary for growth.
Substances going into the developing baby, such as oxygen, never interact with the substances leaving the baby, such as waste products. They travel through the umbilical cord through two separate blood vessels. Lung development is normally complete after weeks of pregnancy. This is why even late preterm babies often experience difficulties breathing. Developing babies are surrounded by amniotic fluid , and their lungs are filled with this fluid.
But these breaths provide them with no oxygen, and only refill the lungs with more amniotic fluid.
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