How to respond and act to a baby that is desatting?

Specialties NICU

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Hi There,

I am looking for some sound advice and rationale for how you should correctly and appropriately respond to a desatting baby and the processes that you would follow.

If the baby was going blue then you would start to bag using the bag valve mask. With the bag valve mask how much oxygen would you give? Would you give 15 litres? And would you start doing compressions or just rescue breaths and what rate would you do this?

The reason i ask about compressions is because respiratory arrest is more common in neonates.

Im trying to find a youtube video of bagging a neonate and the whole process but they are sketchy.

I would like to talk this scenario through with you all to improve my understanding.

And has anyone froze/panicked during an emergency? This happened to me and i felt really stupid and embarassed. How do you harden up and just spring into action?

Thank-you. :)

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Specializes in NICU.

It depends on the situation. Sometimes blow-by is enough to pull a baby out of a desat. Sometimes PPV is required. And if a baby is truly centrally apneic, breaths should be given until the baby starts to breathe or until someone arrives who can intubate. We use a Mapleson bag and set the flow to 8-10L. And the amount of oxygen depends on what is going on. I would usually start a little lower (maybe 40%) and increased the FiO2 as necessary. There is no one right answer in this scenario.

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It entirely depends on the baby and what might be causing them to desat. If it's a bigger baby and reflux causes them problems, then sitting them up or stimulating them is usually enough to get them to stop periodic breathing and bring their sats back on their own. If it's a small baby with an immature respiratory drive that is causing them to go apnic or periodic/shallow breath I'll usually give them an opportunity to fix it on their own. If they don't bring themselves back up I'll then increase their FiO2 and do some tactile stimulation and see if that helps. If not, or the desat worsens, I'll get an RT and start with blowby at 100% and then move to facial CPAP/bagging. If their HR ever drops or if bagging does not help then it's time to hit that 'ole code button and start the party.

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Specializes in NICU.

Let's be clear that compressions are ONLY started in the case of severe bradycardia, traditionally

The first thing to do is to try to determine why the baby is desatting. You won't always know, but once you get to know a baby, it may be easier to assess. If you think it's related to reflux (they are spitting up or choking), immediately pause the feed, and pat their backs to help clear their airway, using suction if needed. If it's related to apnea (cessation of all breathing), you need to give them tactile stimulation and then supplemental oxygen as needed.

Don't get too hung up on the amount of liter flow; although 15 seems a bit excessive. Concentrate on delivering the oxygen to the infant via blow-by, PPV, and titrating the FiO2 as needed. Don't start on 100% for the preemies, as this causes free radicals and increases their risk for ROP. Titrate up as per the situation warrants.

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Thankyou everyone for your help.

Could I just clarify that a blow by means to inflate the bag valve mask by hand, to give rescue breaths?

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Specializes in NICU.

Blow-by just means holding the mask by their face so that air with a higher concentration is available for them to breathe. It does not mean that you use the mask to make a seal over their face.

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Specializes in NICU.

Keep in mind that if you are using a ambu bag, there is no free air coming through; you MUST squeeze the bag in order to give any oxygen.

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Specializes in NICU.

Oh, right. I always forget that because we do not use self-inflating bags.

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Ok thankyou everybody for making it clearer. :)

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