These are the most important steps that always repeated and evaluated in neonatal resuscitation: evaluation on neonatal, making decision on what will be done, and doing the chosen way. The evaluation is done based on : respiratory function, heart rate, and skin appearance, so that resuscitation begin on these condition.

Drying and suck the mucus stimulate respiratory function and if it is not adequate can continue by tactile stimulation (clapping or flicking away foot palm or stroking back, stomach, chest, and extremity of baby)

Dangerous activity that forbidden in giving stimulation on neonatal respiratory function are:

• Clapping the neonatal back, it can cause injury.
• Pushing chest, can cause bone fracture, pneumothorax, respiratory distress, and death.
• apply thigh to stomach can make hepar and lien rupture.
• dilatation of anus sphingter can make rupture it.
• using ice compress or warm compress can cause hypothermia, hyperthermia and burn wound.
• shaking neonatal body can effect cerebral damage.

Epinephrine, sodium bicarbonate, and naloxone are usually used in neonatal resuscitation.

1. Epinephrine (suggested 1:10.000) is cardiac stimulating drug, given when heart rate always <60times/min after applying ventilation during 30 minutes and continued by chest compression followed with ventilation during 30 minutes. It can give by endotracheal tube (ETT) or umbilical vein, but giving by ETT is faster way and easy to get than umbilical catheter.
2. Sodium bicarbonate is given with indication: suspected metabolic acidosis proven by blood gas analysis test result. It is not applied until the lung get adequate ventilation. Sodium bicarbonate is very easy burn, so that don’t give it through Endotracheal tube.
3. Naloxone

Indication for this drug are:

• Neonatal with normal heart rate and normal skin appearance after positive pressure ventilation but present respiratory distress, failure to breathe spontaneously and bad muscle tonus.
• History of giving narcotic on mother in last 4 hours.

Naloxone is not given for neonatal whose mother suspected depended of narcotic or mother used methadone maintenance therapy because can make seizure on neonatal. (doc b3ty)