THE CONTEXT
Newborn services are organized according to the infant's care needs. The passage describes four levels of care, India's newborn care facilities, and medication use during resuscitation.
Four levels of newborn care
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Level 1 cares for normal term newborns and stable newborns of 35–36 weeks' gestation. It stabilizes small and sick neonates before transfer to a higher level.
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Level 2 cares for neonates of at least 32 weeks' gestation or at least 1500 g birth weight and those with moderate sickness. It provides CPAP and brief ventilation and serves as a step-down unit for levels 3 and 4.
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Level 3 cares for neonates below 32 weeks' gestation or below 1500 g birth weight and those with critical illnesses. It offers a full range of respiratory support.
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Level 4 provides advanced subspecialty care, including options for cardiac surgery, pediatric surgery, and extracorporeal membrane oxygenation.
National Health Mission facilities in India
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Newborn care corners are present at all birthing facilities to meet basic newborn needs and identify and refer at-risk or sick neonates.
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Newborn stabilization units operate at the first referral level.
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Special newborn care units are located at district hospitals and medical colleges to care for sick neonates.
Epinephrine during resuscitation
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Epinephrine is indicated when the heart rate remains below 60/min after 60 seconds of effective positive pressure ventilation and chest compressions.
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Its effects are inotropic, chronotropic, and peripheral vasoconstriction.
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The table lists an epinephrine concentration of 1:1000, with 1:10000 administered at 0.2 mL/kg. A repeat dose may be given every 3–5 minutes.
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The intravenous route through the umbilical vein is listed; the endotracheal route may be used if intravenous access is unavailable.
Volume expansion
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Normal saline or Ringer lactate is indicated for acute bleeding with hypovolemia, especially in the setting of antepartum hemorrhage.
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Increasing intravascular volume improves perfusion.
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The listed dose is 10 mL/kg over 5–10 minutes through the umbilical vein.