Resuscitation of the newborn.

Effective resuscitation of the newborn requires knowledge of the cause of depression. Four major causes are trauma, asphyxia, medication, and malformation. More than one of these may contribute to depression in a single infant. The first principles of resuscitation are to avoid cooling the infant and to establish an airway. Infants with an Apgar score of 3 to 4 at one minute usually need bag-and-mask ventilation, while those with scores of 0 to 2 require immediate ventilation, preferably by means of endotracheal intubation. Severely depressed infants may also require chemical resuscitation and closed cardiac massage. Fetal depression caused by narcotic analgesics given to the mother can be reversed with the use of naloxone hydrochloride (Narcan). Infants asphyxiated on the basis of malformations may benefit from expeditious diagnostic and therapeutic procedures performed in the delivery room.