Effective sign of neonatal resuscitation is:-

Ans. (c) Heart rate increasedRef: Nelson Textbook of Pediatrics 20th Ed; Page No-845-46 and NEP guidelines 7th Ed 2016* Begin the resuscitation with antenatal counseling (when appropriate) and a team briefing and equipment check. Maintain normal body temperature of neonate during resuscitation, target temperature being 36.5-37.5degC in axilla.* Approx. 10% neonates need some assistance and upto 1% need active resuscitation.* Current evidence suggests that cord clamping should be delayed for at least 30-60 seconds for most vigorous term and pre-term neonates.* Most successful indicator of response to resuscitation is increase in heart rate. An electronic cardiac monitor is the preferred method for assessing heart rate.* Oxygen concentration method:# Resuscitation is gestational age at or above 35 weeks begins with 21% oxygen (room air)# In those < 35 weeks: Begin with 21 -30% oxygenationNewborn Resuscitation Algorithm# 100% 02 used whenever you give chest compression and wean 02 if HR improves* Stimulation can be done by: Rubbing the back trickling the sole once.* Mouth suctioned first, followed by nose. No role of routine tracheal suctioning.* To prevent hypoxic-ischemic tissue (brain, heart, and kidney) injury associated morbidity and mortality and reestablish adequate spontaneous respiration and cardiac output; neonatal resuscitation preferred.* The steps in neonatal resuscitation follow the TABCs:# T: Provide warmth, dry the baby and remove the wet linen.# A: Position the infant, clear the airway, and establish a patent airway by suctioning and if necessary, insert an endotracheal tube to ensure an open airway.# B: Tactile stimulation to initiate breathing or positive- pressure ventilation using either bag-and-mask or through an endotracheal tube as necessary.# C: Simulate and maintain the circulation of blood with chest compression and medications as indicated.* Flow-chart outlines the steps to follow for immediate neonatal evaluation and resuscitation.CPAP= continuous positive airway pressure; ET = endotracheal; HR= heart rate; IV= intravenous; PPV= positive pressure ventilation* If heart rate less than 60 beats/min with poor perfusion is an indication to begin chest compressions.* If the bradycardia exists, vascular access should be found; at that time resuscitative epinephrine should be administered in a repeatedly manner in every 3-5 min for persistent symptomatic bradycardia.* Atropine can also be given in such type of cases; if vagal tone increases (e.g., in the setting of head injury with raised intracranial pressure) or primary atrioventricular block is suspected.* Medications are rarely required but should be administered when the heart rate is <60 beats/min after 30 sec of combined ventilation and chest compressions or during asystole.* The umbilical vein can generally be readily cannulated and used for immediate administration of medications during neonatal resuscitation (See Extra mile).* If intravenous access is not available and/or for naloxone; the endotracheal tube is used for the administration of epinephrine* The dose of Epinephrine: 0.1-0.3mL/kgof a1:10,000 solution, given intravenously or intratracheally for asystole or for failure to respond to 30 sec of combined resuscitation. The dose may be repeated every 3-5 min.Extra MileGuidelines for Tracheal Tube Size and Depth of InsertionTube Size (mm internal diameter)Depth of Insertion from Upper Lip (cm)Weight (g)Gestation (week)2.56.5-7<1,000<2837-81,000-2,00028-343/3.58-92,000-3,00034-383.5/4.0>9>3,000>38