Since poor arterial oxygen saturation leads to compromised cardiac function, the oxygen concentration should be adjusted to 100% as soon as compressions are started.

Chest compressions for neonates and infants are delivered in coordination with PPV. One breath is given after every three compressions. The compressor voices, “One, and two, and three, and breathe.” At the word “breathe,” the compressor holds chest compressions to allow the team member in charge of ventilation to deliver a breath.

Each compression event must be only one-half of a second, and the first compression coincides with the exhalation phase after each positive pressure breath. This method ensures a rate of 90 compressions and 30 breaths per minute.

Related Video – 2 Rescuer CPR for Infants

Hand-Position During Compressions

The two thumb-encircling hand technique generates better pressures and coronary perfusion, with less fatigue to the provider. The pressure is applied directly to the lower one-third of the baby’s sternum just below the nipple line. Compression depth must be approximately one-third of the anteroposterior diameter of the newborn’s chest, and the encircling hand should not squeeze the baby’s chest. After each compression, the compressor should release pressure to allow full chest recoil while keeping both thumbs on the chest.

Two-thumb encircling hand technique for infant chest compressions.

Positioning the Team Members

The team member at the head of the patient is responsible for providing PPV via face mask and intubating. When chest compressions are needed, the compressor stands on one side of the warmer.

Team members positioned around the infant’s bed.

Once the infant is intubated with adequate ventilation, the person delivering PPV can move to either side of the bed while the chest compressor moves toward the baby’s head. The position at the head of the bed results in less fatigue for the compressor.

The compressor and the team member responsible for medication administration may need to change positions. The position at the infant’s head is also the best place to perform umbilical venous catheterization.