- Preparing for Resuscitation
- Equipment, Apgar Scoring, and Family Communication
Equipment, Apgar Scoring, and Family Communication
Equipment verification
Equipment failure during resuscitation is preventable. Every piece of resuscitation equipment should be verified as functional before every delivery (not assumed to be ready from the previous shift). The standard resuscitation equipment checklist covers five categories (Table 3):
| Category | Key items to verify |
|---|---|
| Warmth | Radiant warmer on and pre-warmed; warm towels or blankets; plastic wrap or bag (for <32 weeks) |
| Suction | Bulb syringe; wall suction set to 80-100 mmHg; suction catheter (10 or 12 Fr) |
| Airway | Flow-inflating or self-inflating bag; T-piece resuscitator; masks (sizes 0 and 1); laryngoscope with working blade and light; ETT sizes 2.5, 3.0, 3.5 mm; stylet; CO₂ detector |
| Monitoring | Pulse oximeter and right-hand probe; ECG leads and monitor; stethoscope |
| Medications | Epinephrine 1:10,000 (0.1 mg/mL) drawn and labeled; normal saline for volume expansion; umbilical catheter tray |
Any deficiency identified during the equipment check must be corrected before the delivery proceeds where clinically possible. Equipment that has not been verified should be treated as unavailable
Apgar scoring
The Apgar score provides a standardized snapshot of the newborn's condition at one and five minutes of life, scored across five signs (Table 4) . It is not used to guide resuscitation decisions, as resuscitation begins before the one-minute score is available and should not be delayed to complete the assessment. Its value is retrospective: it documents the newborn's response to birth and to any resuscitation that occurred.
Sign | 0 | 1 | 2 |
|---|---|---|---|
| Appearance (color) | Blue or pale all over | Blue at extremities, pink body | Pink all over |
| Pulse (heart rate) | Absent | <100 bpm | ≥100 bpm |
| Grimace (reflex irritability) | No response | Grimace | Cry or cough |
| Activity (muscle tone) | None | Some flexion | Active motion |
| Respiration | Absent | Weak or irregular | Strong cry |
Scores are recorded at one and five minutes. If the five-minute score is below 7, scoring continues every five minutes until 20 minutes or until two consecutive scores of 7 or above are achieved.
The Apgar score documents what happened; it does not direct what to do. All resuscitation decisions are made in real time based on the infant's response, not based on the score.
Brief family communication
When time allows, two minutes with the family before a high-risk delivery matters more than most providers think. The team leader or attending provider should explain who is present, what the team is prepared to do, and how the family will be kept informed. This does not need to be lengthy (a clear, calm two-minute interaction at the bedside is sufficient). If the delivery is emergent, family communication should occur as soon as the newborn is stabilized.
Medically reviewed by: Kim Murray, RN, MS., Medical Educator
