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NEWBORN RESUSCITATION
Dr. Dhana Raj Aryal
Chief Consultant Paediatriian
!ead" De#t. of Neonatolo$y
%aternity !os#ital
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W.!.O. esti&atesW.!.O. esti&ates
Seven million perinatal deaths/yearSeven million perinatal
deaths/year
mostly in developing countriesmostly in developing countries
4 million newborns suffer4 million newborns
suffermoderate/severe birth asphyxiamoderate/severe birth
asphyxia
About 800,000 babies die and about the About 800,000
babies die and about the
same number develop sequelae same number develop sequelae
epilepsy, mental retardation, c!p!, learningepilepsy, mental
retardation, c!p!, learning
disabilities etc!disabilities etc!
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In Ne#al
"erinatal asphyxia is one of the
commonest causes of perinatal
death
#quipment for neonatal resuscitation
are lac$ing in many health facilities in%epal&ery few are
trained in the correct
technique of neonatal resuscitation
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%eonatal mortality constitutes ''( of )*+
irth asphyxia is one of the commonest
causes of neonatal mortality -.11(2
+eduction in deaths due to asphyxia will
have significant impact in reduction of )*+
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%eonatal and )nfant *ortality +ate in
%epal
3ear )*+ %*+ ( of
)*+55 80 4' 8
55' 65 0 '1
.00 '4 15 '0
.00' 48 11 ''
7oal 14 6 11
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%early 50( of babies do not require any
resuscitative measures
About 0( require some resuscitation and
( will require advanced resuscitation
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here is a very important relationbetween the duration of
asphyxia and
initiation and establishment of normal
breathing following assistedventilation
A slight delay in starting assistedventilation
results in much longer time
in starting and establishing normal
breathing
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9uration of Asphyxia
ime of assisted ventilation
*ins 7asping reathing
0 .!1 5!6
.! 5!4 .0!
1!' 10
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eing "repared
:hile in ./1 of the births, asphyxia
could be anticipated, in /1, it can;t be
anticipated
herefore one should be prepared to
deal with birth asphyxia in all births
promptly and adequately
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eing "repared
Anticipation *edical history
#quipment #ssential equipment ofneonatal resuscitation
S$illed personnel . persons< and at leastone should be
s$illed in all aspects of
neonatal resuscitation
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)nitial Steps)nitial Steps
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)nitial Steps
9ecide if newborn needs resuscitation
"rovide :armth
=pen airway and provide the initial steps of
resuscitation
+esuscitate when meconium is present
"rovide freeflow oxygen when needed
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3 0
s e
c o n
d s
•Term Gestation?
•Clear of Meconium?
•Breathing or crying?
•Good Muscle Tone?
Yes
Routine Care
•Provide warmth
•Clear irway if needed
•!ry•ssess color
•Provide warmth
•Position clear airway
"as necessary#
•!ry$ stimulate$ re%osition
&o
'valuate Res%$ (R and
Color
'i(e Su##le&entary O)y$en
Breathin$" !R*+,,"
Cyanoti
O-ser(ational CareBreathin$" !R*+,,"Pin
'ndotracheal intu)ation may )e
considered at several ste%s
Pin
Birth
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As$ following questions within
few seconds of birth )s the baby born at Term gestation>
)s the amniotic fluid clear of
%econium >
)s the baby breathing or Crying >
)s the %uscle tone good>
Gasping is a significant problem and
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:hat do you do after:hat do you do after
resuscitationresuscitation
+outine ?are
%early 50( of newborns need this
"rovide warmth by $eeping the baby over motherschest and
abdomen
?lear the airway by turning head to one side
?lear airway by wiping the baby;s mouth and nose
9ry
#valuate color
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)nitial Steps)nitial Steps
"rovide warmth
"osition< clear airway as necessary
9ry, stimulate and reposition
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"rovide warmth"rovide warmth
"laced under radiant warmer
@eave the baby uncovered
under warmer
to allow full visualiBation
to permit radiant heat toreach the baby
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?ontd!!!?ontd!!!
"remature babies more vulnerable to cold stress
@arger body surface area, thin s$in
@ess subcutaneous fat, decreased metabolic
response
Additional warming techniques "lastic bags
*onitor for Cyperthermia
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)nitial Steps)nitial Steps
"rovide warmth
"osition< clear airway as necessary
9ry, stimulate and reposition
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"osition by slightly extending the"osition by slightly extending
the
nec$nec$
Shoulder +oll
Sniffing "ositionSniffing "osition
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"osition by slightly extending the"osition by slightly extending
the
nec$nec$
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?lear Airway?lear Airway
Secretions removed from airway with a
towel/ bulb syringe/ suction catheter
?opious secretions turn face to side
7entle suction "ressure D 00 mm Cg
*outh before %ose -* before %2
Stimulation of posterior pharynx causes
&agal stimulation and bradycardia stop
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?lear Airway?lear Airway
*ethod depend on
! "resence of meconium
.! aby;s level of activity
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?lear Airway?lear Airway
*outh Eirst*outh Eirst
andand
hen %osehen %ose
*outh Eirst*outh Eirst
andand
hen %osehen %ose
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?lear Airway?lear Airway
%eoniu& Stained A&nioti /luid
+outine intrapartum suctioning of
*outh and %ose of babies bornthrough *SAE is no longer
advisable
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*econium present and baby is*econium present and baby is
&igorous&igorous
.E or 4E suction catheter or bulb
syringe for suction of mouth or nose
# suction not required
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&igorous aby 9efinition&igorous aby 9efinition
Strong respiratory
efforts
7ood muscle tone
Ceart rate F 00 bpm
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*econium present and baby is*econium present and baby is
%ot &igorous%ot &igorous
Administer free flow oxygen throughout
?lear mouth and posterior pharynx
)nsert endotracheal tube into the trachea
Attach the # tube to suction source
Apply suction as # is slowly withdrawn for
not more than 1 seconds
+epeat as necessary until no meconium or
heart rate indicates further resuscitation
* i " t d b* i " t d b
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*isuali+ing the glottis and suctioning
meconium from the trachea
*econium "resent and aby*econium "resent and aby
is %ot &igorousis %ot &igorous
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*econium Aspirator *econium Aspirator
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*econium Aspirator *econium Aspirator
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*econium Aspirator *econium Aspirator
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*econium Aspirator *econium Aspirator
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*econium Aspirator *econium Aspirator
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+ecommendations+ecommendations
?urrent guidelines not based on meconium
consistency
echniques such as squeeBing the chest,
occluding the airway, inserting a finger in
the baby;s mouth harmful not
recommended
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)nitial Steps)nitial Steps
"rovide warmth
"osition< clear airway as necessary
9ry, stimulate and reposition
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9ry, stimulate to breathe9ry, stimulate to breathe
and repositionand reposition
Gse prewarmed absorbent towels or
blan$ets
Heep head in Isniffing; position to maintain
good airway
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9ry, Stimulate to breathe9ry, Stimulate to breathe
and +epositionand +eposition
Drythorou$h
ly
Re&o(e 0et
linen
Re#osition the
head
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Stimulation to reatheStimulation to reathe
Suction and drying sufficient stimulation
)f inadequate respiration then additional
tactile stimulation given briefly by
Slapping or flic$ing the soles of the feet
7ently rubbing the bac$, trun$ or extremities
=verly vigorous stimulation harmful
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Acceptable methods of Acceptable methods of
stimulationstimulation
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#valuate +esp, C+ J ?olor #valuate +esp, C+ J
?olor
?ount the +ate for ' seconds and multiply by?ount the +ate for '
seconds and multiply by
0 to get the Ceart rate0 to get the Ceart rate
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)nitial Steps)nitial Steps
"rovide warmth
"osition< clear airway as necessary
9ry, stimulate and reposition
7ive oxygen, as necessary
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Eree Elow =xygenEree Elow =xygen
)f after )nitial Steps
aby breathing well
Ceart +ate F 00 bpm
?entral ?yanosis
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7ive Eree Elow =xygen7ive Eree Elow =xygen
Elow +ate @itres / minute
=xygen tubing
=xygen mas$
Elowinflating bag and mas$
piece +esuscitator
CAN NOT be given reliably with a mask attached to
a Self Inflating Bag
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7iving Eree Elow =xygen7iving Eree Elow =xygen
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7iving =xygen7iving =xygen
"rovide enough oxygen for the baby to
become pin$
=xygen given for long periods must beCeated and Cumidified
Avoid unheated oxygen at high flow rates
-0@/min2 to decrease heat loss
7radually withdraw oxygen when baby pin$
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=xygen=xygen
Eor &ery "reterm abies
Gse an oxygen blender and pulse oximeter during
resuscitation
egin ""& with oxygen concentration between
room air and 00( oxygen
)ncrease oxygen concentration up or down to
achieve saturations between 50 5(
)f C+ does not respond by increasing rapidly to F
00, correct any ventilation problem and use 00(
oxygen
)f no facility of blender use 00( oxygen
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Eurther #valuationEurther #valuation
+espiration
Ceart +ate
?ount for ' seconds and multiply by 0 Eeel pulse at
base of umbilicus or auscultate
F00 bpm normal
?olor )f any of these is abnormal initiate positive
pressure ventilation
Birth
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3 0
s e
c o
n d s
•Term Gestation?
•Clear of Meconium?
•Breathing or crying?
•Good Muscle Tone?
Yes
Routine Care
•Provide warmth
•Clear irway if needed
•!ry
•ssess color
•Provide warmth
•Position clear airway
"as necessary#
•!ry$ stimulate$ re%osition
&o
'valuate Res%$ (R and
Color
'i(e Su##le&entary O)y$en
Breathin$" !R*+,,"
Cyanoti
O-ser(ational CareBreathin$" !R*+,,"Pin
•Provide %ositive %ressure ventilation
•Provide %ositive %ressure ventilation
•dminister Chest Com%ressions
(R , -0 (R . -0
%nea (R , /00
'ndotracheal intu)ation may )e
considered at several ste%s
3 0
s e
c o n d
s
Post resuscitationCare
Medications$ continue PP*$ CC
(R , -0
Pin
3 0
s e
c o n
