71107683 Neonatal Resuscitation

NEONATAL RESUSCITATION

Dr.(COL) C.G.WILSON

PROFESSOR& H.O.D(PAED)

Dr. K.SATYANARAYANA

CONSULTANT(PAED)

KAMINENI HOSPITALS

PREPARATION FOR

NEONATAL RESUSCITATION

Dr. K.SATYANARAYANA

M.D;

CONSULTANT(PAED)

NEONATAL RESUSCITATION

After delivery most of the babies fall into one of

the 4 groups.

1. Fit and healthy (90-95%)

2. Primary apnoea (5-6%)

• Apnoeic and blue

• Inadequate breathing

• HR : 80 – 100

3. Terminal apnoea (0.2 – 0.5%)

• pale, limp

• apnoeic

• HR < 60

4. Dead but resuscitable ( < 0.1%)

Which baby requires resuscitation ?

• No respiratory effort at all

• Feeble and Inadequate effort

• Vigorous respiratory effort but

cyanosed

• Apnoeic due to primary muscle and

CNS disorder

* Anticipation and preparation are key

factors in the management of resuscitation.

Identification of the high risk neonate:

1. PiH

2. DM

3. Oligohydramnios / Polyhydramnios

4. Multiple pregnancy

5. Rh incompatability

6. Postdated pregnancy

7. APH

8. Abnormal presentations

9. Maternal infections and disorders

10. Meconium stained liquor

11. Prolonged labour

12. Cord prolapse / shoulder dystocia

FACTORS OTHER THAN B.A.

REQUIRING RESUSCIATION

1. PT

2. Maternal hypocapnia

3. Maternal drugs depressing CNS

4. Sepsis (GBS)

5. Anemia

6. Primary muscle and CNS disorder

7. Congential malformations of the

airway and CNS

PRIMARY APNOEA

Shallow respiration

HR & BP Responds to stimulation

Tone and O2 inhalation

SECONDARY APNOEA

HR & BP Requires resuscitation

Flaccid

Primary apnoea and secondary apnoea may occur

even in utero. Apnoea at birth assume it as

secondary apnoea only.

Secondary apnoea and brain damage.

Asphyxia is defined as combn of hypoxemia,

hypercapnia and metabolic acidosis.

Hypoxemia & acidosis

Constriction of arterioles in lungs

Constriction of the PBF, Perfusion

arterioles of other

organs (brain&heart

spared)

Organ damage Oxygenation of tissues

PREPARATION FOR RESUSCIATATION

Personnel:

• 1 person skilled in resuscitation should attend

every delivery

• 2 persons – depressed newborn

• 1 person – Intubation & ventilation

• 2nd person – Monitor HR & chest compressions

• Multiple pregnancy – Separate team for each

infant

NEONATAL RESUSCITATION SUPPLIES

AND EQUIPMENT

Suction equipment:

• Bulb syringe

• Mechanical slow suction (100mm Hg) with

tubing

• Suction catheters, 5F or 6F, 8F and 10F or 12F

• Meconium aspiration device

Bag-and-mask equipment:

• Neonatal resuscitation bag with a pressure-

release valve and / or pressure manometer and

reservoir (the bag must be capable of delivering

90% to 100% oxygen)

• Face masks, newborn and premature sizes

(masks with cushioned rim preferred)

• Oxygen with flow meter (flow rate up to

10L/min and tubing (including portable oxygen

cylinders)

Intubation equipment:

• Laryngoscope with straight blades, No. 0

(preterm) and No.1 (term)

• Extra bulbs and batteries for laryngoscope

• Endotracheal tubes: 2.5, 3.5, and 4.0mm ID

• Styllet (optional)

• Scissors

• Tape for securing tracheal tube

• Laryngeal mask airway (optional)

Umbilical vessel catheterization:

• Sterile gloves

• Scalpel or scissors

• Providone – iodine solution

• Alcohol sponges

• Umbilical tape

• Umbilical catheters: 3.5F, 5F

• Three-way stopcock

• Flushing solution

Miscellaneous:

• Gloves and appropriate personal protection

• Radiant warmer or other heat source

• Firm, padded resuscitation surface

• Clock (timer optional)

• Warmed linens (at least two per delivery)

• Stethoscope

• Tape, ½ or ¾ inch

Miscellaneous:

• Cardiac monitor and electrodes (optional)

and/or pulse oximeter with probe.

• Oropharyngeal airways

• Syringes 1, 2, 5, 10, 20 and 50mL

• Needles- 18, 21 & 25 gauge or puncture device

for needle less system.

Medications:

• Administration of drugs is rarely indicated in resuscitation

of the NB infant. However, in rare cases the following

medications are used:

• Epinephrine 1:10,000 (0.1mg/mL) Dilute 1ml of 1:1000

solution and keep ready (0.5ml. + 4.5ml NS)

• Isotonic crystalloid (normal saline or Ringer’s lactate) for

volume expansion. (Albumin is no longer recommended). 0-

ve red cells may be used.

• Sodium bicarbonate dilute 7.5% solution 1:1 with DW to

get approximate concentration

• Naloxone hydrochloride 0.4mg/mL 1-mL ampoules; or 1.0

mg/mL 2-mL ampoules

NEONATAL RESUSCITATION

PROTOCOL

STEPS OF RESUSCITATION

Dr(col) C.G.WILSON

PROFESSOR& H.O.D(PAED)

STEPS OF RESUSCITATION

ON YOUR MARCH…….………GET SET

PREVENTION OF HEAT LOSS

PROVIDE WARMTH

AIRWAY CLEARING & CLEANING

INITIATION OF BREATHING

EVALUATION

PREVENTION OF HEAT LOSS

& PROVIDE WARMTH

DRYING – PREWARMED TOWEL

REMOVE WET TOWEL

RADIANT WARMER

EUTHERMIC ATMOSPHERE

AIRWAY MANAGEMENT

EXCESSIVE SECRETIONS &

M S A F BEFORE DRYING

POSITION - ON BACK – FLAT

HEAD SLIGHT EXTENSION

& ONESIDE

TOWEL - SHOULDER BLADE

AIRWAY CLEARING

BULB SYRINGE

De Lee MUCUS SUCKER

MECHANICAL 100mm Hg

INITIATION OF BREATHING

TACTILE STIMULATION

HARMFUL ACTIONS CONSEQUENCES

1. SLAPPING BACK BRUISING

2. SQUEEZING RIB CAGE # PNEUMO

3. FORCING THIGHS ONTO RUPUTURE OF ABDOMEN LIVER, SPLEEN

4. HOT / COLD COMPRESS HYPO / HYPER THERM

BURNS

INTER-RELATIONSHIP - RESP, HR, COLOUR

AT BIRTH - SOME -CYANOSIS

60 – 90 SEC - PINK / ACROCYANOSIS

RARELY - RESP REGULAR FREE

HR ≥ 100 MT FLOW

CENTRAL CYANO OXYGEN

INITIAL - HIGH CONCN O2 (80%)

- GRADUAL WEANING TILL

PINK AT ROOM AIR

FREE FLOW OXYGEN

OXYGEN – HEATED, HUMIDIFIED

5L / mt

NEARER TO NOSE

1/2 INCH-80% 1 INCH-60%

2INCH-40%

EVALUATION

NO BREATHING/GASP AFTER 2 TACTILES

STIMLNS

CHECK:

RESP EFFORT

HR

COLOUR

BREATHING (N)

HR > 100 / mt SUPPORTIVE CARE

PINK COLOUR

IF NOT - PROTOCOL

PROTOCOL

GASP / NO BREATHING & HR < 100

CHECK HR FOR 6 SEC X 10

CHEST COMPRESSION &

BMV – 30 SEC (100%)

HR 60 - 100 ± APNOEA

BAG & MASK WITH OXYGEN

HR < 60 ± APNOEA

30 SEC

(N) BREATHING HR

≥100 & PINK

BMV 30 SEC FREE FLOW

OXYGEN

HR < 60

HR ≥ 100 &

PINK PINK AT

ROOM AIR

DRUGS & INTUB

OROGASTRIC TUBE FOR BMV > 2 Mts

BAG & MASK VENTILATION

BAG

VALVE ASSEMBLY

SELF INFLATING / AMBU BAG

AIR INLET

OXYGEN – INLET

VALVE ASSEMBLY

PATIENT OUTLET

FACE MASK CUSHIONED RIM

0, 1, 2 SIZES

ROUND / CONICAL

CHECK EQUIPMENT

-BAG – BLOCK OUTLET & SQUEEZE

--PR RELEASE VALVE – HEAR AIR

RELEASE

CLEAN – 2% GLUTARALDEHYDE 20-40’

--WASH WITH DISTD WATER

PROCEDURE – B M V

• POSITION

• TEST – MOUTH SEAL – 2 -3 SQ. CHEST RISE

• INITIAL HIGHER PR 30 -40 CM H20

• 40 PER MT ( 30 – 60)

• CHEST COMPRESSION – 90 / mt

(ONE SQ. AFTER 3 COMPRESSIONS)

• AFTER 30 SEC, EVALUATE HR, BR, COLOUR

CONTRA

•DIA HERNA

•M S A F WITH RESP DEPRESSION (INTRA

PARTUM SUCTIONING PRIOR TO BMV)

CHEST COMPRESSION

RHYTHMIC COMPRESSION OF

STERNUM THAT:

• COMPRESS HEART AGAINST SPINE

• INCREASE INTRATHORACIC PR

• CIRCULATE BLOOD TO VITAL

ORGANS

• HEART FILLED WHEN PR RELEASED

METHOD

Two thumbs

encircling hands

Two finger

technique of chest

compression – In

the two fingers

technique the

index and the

third finger of the

hand is used

LOCATION & DEPTH

RATE OF COMPRESSION

COMPRESSION / RELEASE ACTION 90 / Mt

VENTLN – 30 / mt RATIO 3 : 1

HALF SECOND FOR EACH EVENT

• IN 2 SECONDS – 3 COMPR & 1 SQ

• IN 60 SECONDS – 90 COMPR & 30 SQ

EVALUATE AFTER 30 SEC

HR 6 SEC X 10

-CAROTID, BRACHIAL, FEMORALS FELT

PRECAUTIONS: • DO NOT REMOVE FINGER / THUMB IN BETWEEN

• FEEL THE PULSES FOR EFFECTIVENESS

• DO NOT SQUEEZE CHEST