High quality neonatal resuscitation plays a key role for saving premature babies and reducing the risk of disabilities. Resuscitation is not necessary in the majority of the newborns – they adapt to life outside the womb without substantial additional support.

Unlike full-term babies, the premature newborns (about 6% of all and 80% of those born weighing less than 1500g) require different volume of primary resuscitation in the delivery room. It is carried out by a team including: a neonatologist (if necessary, a second doctor is included), an obstetrician, a midwife, and a nurse.

In Bulgaria, according to the Neonatology standard, all rooms are equipped with facilities for primary resuscitation of newborns. Resuscitation in the delivery room is done following unified protocols, mandatory for all involved in this process.

Preparation before birth. It includes heating the reanimation table, an aspiration system, and the provision of oxygen.

Steps of neonatal resuscitation - "The Golden Minute":

  • Patent airways
  • Effective breathing
  • Heart rate, circulation
  • Medications
  • Review and assessment

Immediately after birth, the premature child is taken away and dried with a warm blanket. It is placed of resuscitation table with a direct heating source. The nose, the mouth and the stomach are aspirated (cleaned) with a small suction catheter. A sensor is attached to the hand or the leg, by which the cardiac function and oxygen saturation in the blood in the first minutes after birth are being followed. The neonatologist evaluates further treatment, depending on the condition of the premature baby, as the most important indicators are breathing and cardiac function. Premature babies, and especially those born weighing less than 1500 g and before gestation week 32, are usually not able to show effective spontaneous breathing.

Depending on the child's condition, the neonatologist takes the following actions:

  1. Mechanical stimulation: smoothing movements with fingers along the spine, on both sides of the breasts, massaging the feet.
  2. Oxygen delivery.
  3. Ventilation with oxygen mixture via balloon (Ambutype) through a facial mask. It fits tightly to the face, covering the nose and mouth of the child. If the child is breathing independently but should be supported, shorter tubes called nasal cannulas can be put in place. They fit tightly to the nostrils and a heated air mixture, enriched with oxygen, is delivered to the child through them.

Another way to assist the breathing of a premature baby (especially with a weight of less than 1500 g) is intubation – a tube is introduced via the nose, less frequently orally, into the trachea, which is then linked to a pulmotor. In this way, the breathing of the baby is done by the machine, which supplies warm air-oxygen mixture and ensures unfolding of the lungs.

The second important indicator that the neonatologist tracks is the cardiac function of the baby. Usually, providing optimal breathing leads to a normalization of the heart rate. If it does not happen and the heart rate remains below 60 / min. or between 60-80 / min. the following shall apply:

A second doctor or resuscitator starts performing external cardiac massage of the baby following a strict protocol. Based on the achieved result, the administration of medicines during the primary resuscitation in the delivery room is being considered. An intravenous route for their application is provided.

After initial stabilization of the basic vital signs of the baby, it is transferred into Intensive Care Unit or a Special care sector for newborns, in a pre-warmed incubator without interrupting respiratory support and reporting of heart rate and saturation of blood oxygen (via monitor), There, the newborn is placed in a prepared personal incubator. Maximum sparing treatment and diagnostic procedures are performed there after the normalization of body temperature.

Who will inform you about the condition of your newborn baby and when?

The resuscitation of your baby is carried in the delivery room. According to your condition, you may see who is taking care of the child, how it looked after birth, what type of care is undertaken, etc. When birth was done via surgery (by Caesarean section) or you have  been applied anesthesia immediately after birth, the fear of the unknown is even stronger.

The neonatologist will come to you once they had finished performing urgent care for your baby and its admittance in the department. You will get from them the following information about the child: gender, weight and height at birth, in what state it was born, what type of care and resuscitation measures had to be done, how is the baby now, where it has been admitted, what is to follow - treatment, tests, what to expect and what is the approximate timeframe. It is better if this information is given in the presence of both parents. If the condition of the mother does not allow it, the first report about the baby is given to the father.

It is a common practice to allow the father to see his child, should he wishes so. It is necessary, that he had been previously prepared in brief for the technical characteristics of the atmosphere in the intensive care sector (light and sound signals, equipment, personnel, etc.), as well as for the look of the child. In this way, he will be able to describe it and tell the mother about the baby. Once the mother is stable, she is allowed as early as possible to see her baby, to touch it and caress it. The neonatologist will give you information about its current state, what treatment was applied, what tests have been done and their results, as well as what the future actions are. You should ask your questions, what is not clear, get yourself informed on the internal order in the department, relating to access to information and to the baby.

Welcome to  "All About Premature Babies" website.
This is a project of "Our premature babies" Foundation based in Bulgaria. The book is a result of a team’s hardwork that includes doctors, psychologists, breastfeeding consultants and premature babies parents. The common information about premature babies which you can find here will help you understand better the situation you've been facing.
Please keep in mind that some of the information related to the neonatal intensive care units is prevalent only in Bulgaria.

We hope that this website and the book are going to help you to be more informed, calm and confident. We wish you and your baby best of luck and health.

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