Neonatal Life Support
Introduction
Most neonates transition to extra‑uterine life without intervention, but a small proportion require immediate stabilisation or full resuscitation. In the emergency department (ED) setting neonatal collapse is uncommon but high‑stakes: the priorities are opening the airway, establishing effective ventilation and preventing hypothermia.
Management and decision thresholds differ from adults - heart rate guides actions and ventilation takes precedence over chest compressions. This section summarises practical, guideline‑based neonatal life support for ED clinicians (Resuscitation Council UK; NICE).
Pre‑delivery and intrapartum risk factors
Anticipate need for stabilisation when any of the following are present and ensure trained personnel and equipment are ready:
- Fetal factors: prematurity (risk increases with decreasing gestation), growth restriction, multiple pregnancy, congenital anomalies.
- Maternal factors: maternal infection, gestational diabetes, pre‑eclampsia/hypertension, high BMI, lack of antenatal steroids when preterm birth likely.
- Intrapartum factors: non‑reassuring CTG, meconium‑stained liquor (especially if the infant is non‑vigorous), instrumental or breech delivery, emergency caesarean, general anaesthesia.
Local policy should define which deliveries require an NLS‑trained clinician present and how to call a neonatal resuscitation team rapidly (Resuscitation Council UK).
Thermal care and delivery environment
Preventing heat loss is essential: hypothermia increases oxygen consumption and worsens outcomes.