The following techniques and procedures are described in this subsection: suctioning, stimulation, oxygen supplementation, bag-and-mask ventilation, pharyngeal and bi-nasal continuous positive airway pressure (CPAP), pharyngeal positive pressure ventilation, endotracheal intubation, gastric tube placement, laryngeal mask airway (LMA) placement, chest compressions, peripheral venous access, umbilical vein/artery catheterization, central venous access (IJ), intraosseous access, and cord clamping. For chest tube placement see chapter entitled “Pneumothorax.”

Unnecessary suctioning is uncomfortable for the infant and may cause lesions in the mucous membrane and occasionally a vagal reflex with subsequent bradycardia, laryngeal spasm and apnea.

Indications for suctioning of the upper respiratory tract

• Excessive amount of amniotic fluid in the oropharynx (e.g., after C-section)

• Green-stained, bloody or smelly fluid

• Prematurity (i.e., preterm newborn infants usually need suctioning)

• Abnormal adaptation, respiratory distress or apnea

• Polyhydramnion

• Visualization of vocal cords during intubation

Rule of thumb for the suctioning of newborn infants(Figure 2.16 and 2.17)

• Always suction the mouth/throat before the nose: Nasal suctioning is a strong stimulus that may lead to aspiration of fluid that is still in the hypopharynx

• Avoid deep (i.e., hypopharyngeal or esophagogastric) suctioning in the first 5 min after birth: Vagal reflex resulting in bradycardia, laryngeal spasm and apnea is possible. Suction only as needed (see above)!

• A vigorous, active, and healthy neonate should be dried, wrapped up and then given to the mother. Attempt to pass naso- or orogastric tube through the esophagus into the stomach 10–30 min after birth (i.e., before the first feeding)

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