However, for many babies, the need for resuscitation cannot be anticipated before delivery. Therefore, be prepared for resuscitation at every delivery. First, observe quickly for any signs of respiratory problems:

Having difficulty in breathing or signs of gasping (shortage of breathing).
Breathing less than 30 breaths per minute or not breathing at all.
The skin becomes cyanotic because of deficiency of oxygen.

If the baby needs resuscitation, quickly clamp or tie and cut the cord, leaving a stump at least 10 cm long for now and then start resuscitation immediately by using the correct size of the face mask.

Position	Place the baby on his back with the neck slightly extended (chin left and head tilt). Put a towel or cloth behind the shoulder to facilitate positioning. Correct position Hyper flexed incorrect position Hyperextended wrong position
Clear airway	Clear the airway or wiping out the mouth with gauze. Suction the baby's nose and mouth gently by using bubble syringe. Reassess the baby's breathing.
Ventilate	Use baby bag and mask to ventilate at 40-60 breaths per minute. Continue to ventilate until the baby breathes independently. Stop after 20 minutes if the baby has not responded. Correct proper mask Incorrect smaller mask Incorrect bigger mask.
Monitor	Keep the baby warm (skin-to-skin). Not bath the baby within 24 hours. Breastfeed as soon as possible. Watch for signs of a breathing problem rapid, laboured, or noisy breathing, blue. The colour of the tongue, trunk. If a breathing problem occurs, stimulate, give oxygen [if available], and refer urgently.

How to ventilate:

Squeeze bag with two fingers or whole hand, 2-3 times.
Observe for the rise of the chest.
IF CHEST IS NOT RISING: Reposition the head or Check mask seal.
Squeeze bag harder with the whole hand.
Once good seal and chest rising, ventilate at 40 -60 squeezes per minute.
Squeeze a bag 2-3 times with two fingers and a thumb. (When you press the bag Count 101 for the first Squeeze, 102 for the second Squeeze, 103 for the third Squeeze to deliver the desired amount oxygen).
Observe the chest while ventilating:

Is it moving with the ventilation?.
Is the baby breathing spontaneously?.

When to stop ventilating?:

When the newborn, breathe spontaneously or cry.
When the newborn breathing is >30 b/m and regular:
Continue resuscitation for 20 minutes until the babies spontaneously breathe. After 20 minutes if the newborn is not breathing spontaneously or birthing is weak and irregular you stop ventilation and urgently refer the child to the health centre or hospital.

When to continue ventilating?

When the newborn breathing is <30 b/m.
When gasping or breathing is irregular.
The baby has severe chest in-drawing.

Immediate assessment and newborn care

If you are attending a delivery or a baby is brought to you immediately after birth, you need to dry and wrap the baby with dry cloth and cover the head and assess any breathing problem:

Assessment and classification of newborns

Signs

Classification

Treatment

If any of the following sign is present:

Not breathing or gasping or

Breathing poorly (less than 30 breaths per minute).

Birth asphyxia

Start resuscitation

Position the baby in the supine position and head tilt-chin lift.

Clear the airway by bubble syringe or clean gauze.

Ventilate with appropriate size mask and self-inflating bag.

If baby remains weak or has irregular breathing after 20 minutes refer urgently to health centre or hospital.

If successful within 20 minutes continue to give essential newborn care.

Follow after 6hrs, 12hrs, 24hrs, 3rd day, 7th day and 6th week.

Breathing >30 b/m

NO Birth asphyxia

Continue with the essential newborn care.

Put the newborn skin-to-skin contact to the mother.

Initiate immediate breastfeeding within 1 hour.

Apply 1% TTC eye ointment in the newborn's eyes.

Give 1 mg Vitamin K IM.

Delay bathing for 24 hours.

Provide four follow-up visits at age 6-24 hrs, three days seven days and six weeks.

Advise the mother when to return for the next visit.

Neonatal resuscitation

Immediate assessment and newborn care

Assessment and classification of newborns