I’m currently on peds anesthesia and behind on reading Annals, which worked out in my favor.  I was looking through the February 2017 issue and there’s an EM:RAP commentary about the neonatal airway.  So I figured I would give you all the highlights from that article.

• At birth, an oxygen level of 60% is normal.  There’s a nice chart showing the oxygen saturation and how it increases after birth.
  • 1 minute- 60-65%
  • 2 minutes- 65-70%
  • 3 minutes 70-75%
  • 4 minutes 75-80%
  • 5 minutes 80-85%
  • 10 minutes 85-95%
• Remember when doing BVM on a neonate, not to press too hard on their face.  Their nose is not stiff and they are obligate nose breathers.  So don’t close off their airway by pressing too hard.
• Don’t worry about using a paralytic in the neonate.  You can either time passing the tube through the cords or just push it through.
• Tube size/Blade size
  • Normally in peds we use the formula (age in yrs/4) + 4
  • For neonates, they suggest the 0-1-2-3 rule: Use a 0 straight blade in a 1-2 kg newborn with a 3.0 mm uncuffed tube
  • They also recommend resting your pinky on the cric to provide your own cric pressure since neonatal airways can be very anterior
• How far to pass the tube
  • 1 kg neonate- 7 cm
  • 2 kg neonate- 8 cm
  • 3 kg neonate- 9 cm