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Newborn care and resuscitation2014 Emergency Care Trauma Symposium
June 24, 2014
Michael Kim, MD
Topics
• Preparation• Initial assessment• Initial intervention and intervention• HR dependent interventions• Timing and use of O2• Use of pulse oximetry• Advanced care
Kattwinkel J et al. Circulation 2010;122:S909-S919Copyright © American Heart Association
Preparation• Gestational age• Multiple?• Pregnancy complications• Provider assignment• Equipments
– Warm towels– Mask, Bag, O2, Suction– Plastic wrap– Oxygen– Proper sized Laryngoscope, blade, ETT, (RT)– EZ IO– Medication– Advanced support
Initial assessment
• Crying • Breathing • Tone
Term, good cry and tone
Stay with mom, keep warm and transport
If not
• Warm, dry, and stimulate• Clear airway with suction bulb/catheter• Monitor and maintain temperature
• If vigorous, support only • If not vigorous, Suction mouth and nose Endotracheal suction
before PPV
Vigorous or not so vigorous?
Assessment of O2 need/administration
• Birth cyanosis: up to 10 min• Excess and/or deficit are harmful• POX: only when sustained resuscitation is anticipated
Assessment of O2 need/administration
• PPV and O2 administration– Goal: achieve target saturation/HR– Start with RA or blended O2– PPV if apnic, gasping or HR<100– increase O2 if HR < 60 after 90 sec of intervention
Definitive airway
• Endotracheal Intubation: – Initial suctioning of depressed meconium stained
baby– BMV is ineffective– Chest compression is needed
• Laryngeal Mask Airway: if mask or ETT unsuccessful
Chest compressions
• Indicated if HR < 60 after 30 sec of ventilation with O2
• 1/3 AP diameter on lower 1/3 of sternum• 2 thumbs encircling the chest• 2 finger method: not ideal• 90 compressions/ min (3:1)
Vascular access
Medications• Epinephrine if
– HR < 60 with adequate ventilation, 100% O2, and Chest compression
– IV: 0.01 -0.03 mg/kg (1:10,000)– ET: 0.05-0.1 mg/kg (1:10,000)
Approach
• Airway• Breathing• Circulation• Dextrose• Environment
Approach
• Airway• Breathing• Circulation• Dextrose (Don’t Ever Forget the Glucose)• Environment
Newborn care algorithm
Initial evaluation Term, cry, breathing, tone (Pox/perfusion not reliable)
Factors Resp effort, HR, tone , time(POx: later)
Initial intervention Warm, dry, sxn, stim
CPAP indication If resp distress with HR>100
PPV indication if gasping, apnic or HR<100
Oxygen indication If HR<60 after PPV x 90sec
Compression indication If HR<60 after PPV with O2 x 30 sec
IV Epi dose 0.01-0.03 mg/kg (1:10,000)
ET Epi dose 0.05-0.1 mg/kg (1:10,000)
Vascular access Umbilical catheter
Summary
• Preparation• Crying, breathing and tone• Warm, dry and stimulate• Pulse Ox reading misleading• ABCDEFG