NewbornNe wborn Resuscitation
Medical Directive
An Advanced Care Paramedic may provide the treatment prescribed in this Medical
Directive if authorized .
Indications
Newborn patient .
Conditions
PPV CPR
Age < 24 hours Age < 24 hours
LOA N/A LOA N/A
HR < 100 bpm HR < 60 bpm
RR N/A RR N/A
SBP N/A SBP N/A
Other N/A Other After 30 seconds of
PPV using room air
EPINEPHrine
Age < 24 hours
LOA N/A
HR < 60 bpm
RR N/A
SBP N/A
Other After 30 seconds of PPV
AND 30 seconds of CPR
Contraindications
PPV CPR
Obviously dead as per BLS PCS Obviously dead as per BLS PCS
Presumed gestational age less than 20 Presumed gestational age less than 20
weeks weeks
EPINEPHrine
Allergy or sensitivity to EPINEPHrine
Presumed gestational age less than 20
weeks
Treatment
Consider PPV as per the treatment flowchart
Consider CPR as per current Heart and Stroke Foundation of Canada Guidelines
Consider EPINEPHrine
Age
< 24 hours
Route
IV/IO ETT *
0.1 mg/mL = 0.1 mg/mL =
Solution
1:10,000 1:10,000
0.01 mg/kg 0.1 mg/kg
Dose
(0.1 ml/kg) (1.0 ml/kg)
Min. single dose 0.05 mg (0.5 mL) N/A
Max. single dose N/A 0.3 mg (3.0 mL)
Dosing interval 4 min N/A
Max. # of doses N/A 1
*EPINEPHrine is to be administered IV/IO after the single ETT dose if the
conditions are still met
Treatment
Newborn Patient
Targeted Preductal SpO2
(Right Hand)
1 min 60% - 65% Provide warmth;
2 min 65% - 70% Term gestation and clear airway as necessary
3 min 70% - 75% good muscle tone and Yes (do not routinely suction)
breathing or crying? dry; and
4 min 75% - 80%
ongoing evaluation
5 min 80% - 85%
10 min 85% - 95%
No For 30 seconds:
1. Provide warmth;
2. Position/clear airway; and
3. Dry, stimulate, reposition
Evaluate respirations
and heart rate
(consider use of SpO2
and cardiac monitoring)
Breathing and
Yes
HR ≥100 bpm?
Supportive Care
No
Yes For 30 seconds:
1. Provide positive pressure ventilation (BVM/ETT) using
room air
Yes HR ≥ 60 bpm?
No
For 30 seconds:
1. Administer chest compressions; and
2. Provide positive pressure ventilation (BVM/ETT) using
100% oxygen
Yes
HR ≥ 60 bpm?
As long as HR < 60 bpm:
1. Continue chest compressions; and
No
2. Provide positive pressure ventilation (BVM/ETT)
using 100% oxygen;
3. Administer epinephrine 1:10,000:
No IV/IO - 0.01 mg/kg (0.1 ml/kg) q 4 mins, min dose 0.05mg
(0.5ml) OR
ETT - 0.1 mg/kg (1 ml/kg) 1 dose only, max dose 0.3mg
HR ≥ 60 bpm? (3.0ml); and
4. Initiate transport prior to the 3rd dose if possible
Clinical Considerations
If newborn resuscitation is required, initiate cardiac monitoring and right-hand pulse
oximetry monitoring.
Infants born between 20-2520 -25 weeks gestation may be stillborn or die quickly. Initiate
resuscitation and transport as soon as feasible.
If gestational age cannot be confirmed, initiate resuscitation and rapid transport.
If newborn is less than 20 weeks gestation, resuscitation is futile. Provide the newborn
with warmth and consider patching to BHP for further direction.

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