Neonatal Resuscitation

Neonatal Resuscitation
Presented by:-
Dr. Janak
BAMS Intern
Definition
• Neonatal Resuscitation is series of actions, used to assist new born babies, who have difficulty with making the physiological
transition from intrauterine to extra uterine life.
• Goals :-
• To initiate normal breathing of the baby
• To maintain adequate tissue perfusion
• To restore normal core temperature
• To maintain adequate cardiac output
• Indications:-
• Preterm babies
• Fetal distress
• Birth asphyxia
• Hypoxia
• Hyper perfusion
• Severe IUGR
• No crying
• Persistent central cynosis
• Bradycardia
Neonatal resuscitation supplies and equipment
Evaluation
• Evaluation is based primarily on the following three signs: respiration, heart rate (HR) and color. Though all three signs are
evaluated simultaneously, low heart rate is the most important sign for proceeding to the next step.
• Role of Apgar Scores in Resuscitation :-
• The Apgar score is an objective method of evaluating the newborn’s condition (Table ). It is generally performed at 1
minute and again at 5 minutes after birth. However, resuscitation must be initiated before the 1-minute score is assigned.
Therefore, the Apgar score is not used to guide the resuscitation.
• While the Apgar score is not useful for decision making at the beginning of resuscitation, the change of score at sequential
time points following birth can reflect how well the baby is responding to resuscitative efforts. Hence, Apgar scores should
be obtained every 5 minutes for up to 20 minutes, if the 5-minute Apgar score is less than 7.
TABC of Resuscitation
• T-Temperature: Provide warmth, dry the baby and remove the wet linen.
• A-Airway: Position the infant, clear the airway (wipe baby's mouth and nose or suction mouth, nose and insome instances,
the trachea in non-vigorous baby born through meconium stained liqor). If necessary, insert an endotracheal (ET) tube to
ensure an open airway.
• B-Breathing: Tactile stimulation to initiate respirations, positive-pressure breaths using either bag and mask or bag and ET
tube when necessary.
• C-Circulation: Stimulate and maintain the circulation of blood with chest compressions and medications as indicated.
Resuscitation Algorithm
• At the time of birth, one should ask three questions about the newborn:
1. Term gestation?
2. Breathing or crying?
3. Good muscle tone? (flexed posture and active movement of baby denotes good tone)
If answers to all the three questions are ‘Yes’, the baby does not require any active resuscitation and “Routine care” should be
provided. Routine care consists of four steps:
4. Warmth: Provided by putting the baby directly on the mother’s chest in skin-to-skin contact.
5. Clearing of airway if required: Done by wiping the baby’s mouth and nose using a clean cloth. No need to suction
routinely.
6. Dry the baby
7. Ongoing evaluation for vital parameters. Helping mother in breastfeeding will facilitate easy transition to extrauterine
environment.
• If answer to any of the three questions is “No”, the baby requires resuscitation. After cutting the cord, the baby should be
subjected to a set of interventions known as Initial steps.
Maintenance Of Temperature
• Receiving the baby in pre warm towel .
• Provision of heat source .
• Drying the baby.
• Remove the wet linen.
• Procedure:-
1. RECEIVE THE BABY IN A PREWARMED TOWEL
2. PLACE THE BABY IN A PREHEATED WARMER
3. POSITION THE BABY ON BACK WITH THE NECK SLIGHTLY EXTENDED (SNIFFING POSITION)
4. NO HYPEREXTENSION & UNDEREXTENSION
Establishment Of An Open Airway
• Proper positioning the infant.
• Suction the mouth, nose. In some case trachea too.
• If necessary, insert E.T. Tube also.
• Procedure:-
• SUCTIONING OF THE MOUTH SHOULD BE DONE FIRST, THEN NOSE TO PREVENT THE
CHANCE OF ASPIRATION OF SECRETION BY MOUTH
1. USE MECONIUM SUCCAR IN CASE OF MECONIUM ASPIRATION
Initiation Of Breathing
• By tactile stimulation.
• By P.P.V.( positive pressure ventilation).
• Procedure:-
• PROVIDING TACTILE STIMULATION
1. SLAPPING AND FLICKING METHOD –
2. BY SLAPPING AND FLICKING THE BABY’S SOLE OF FEET
a) RUBBING INFANT’S BACK
b) 2. USING FREE FLOW OXYGEN –
c) BY BLOWING OVER THE NEONATE’S NOSE, SO THAT THE BABY BREATHES OXYGEN ENRICHED AIR.FLOW SHOULD
BE 5L / Min
IF THE BABY IS HAVING SPONTANEOUS RESPIRATION, H.R. IS ABOVE 100 BEATS PER MINUTE WITH SKIN COLOR PINK,
THEN BABY NEEDS ONLY OBSERVATION AND MONITORING.
• BAG & MASK VENTILATION –
• SHOULD BE STARTED IF AFTER TACTILE STIMULATION –
1. THE INFANT IS STILL APNEIC OR GRASPING
2. HAVING SPONTANEOUS RESPIRATION BUT H.R. IS BELOW 100 BEATS PER MIN
• FOR B.M.V. –
• BABY'S NECK SHOULD BE SLIGHTLY EXTENDED TO ENSURE OPEN AIRWAY
• MASK TO BE PLACED IN POSITION WHICH SHOULD COVER TIP OF THE CHIN, MOUTH AND NOSE
• VENTILATION SHOULD BE DONE AT THE RATE OF 40-60 BR. PER MIN
Maintenance Of Circulation
• Chest compression
MUST BE PERFORMED ALONG WITH VENTILATION AND 100% OXYGENATION
• METHODS:-IT CAN BE DONE BY TWO METHODS,
1. THUMB COMPRESSION
2. TWO FINGER TECHNIQUECONT
• LOCATION:-THE PRESSURE SHOULD BE APPLIED AT THE LOWER THIRD OF THE STERNUM
• DEPTH :-THE DEPTH SHOULD BE 1½ ΤΟ 3% INCH.
• RATE :-THE RATE OF CHEST COMPRESSION WILL BE 90 COMPRESSIONS AT A MINUTE ALONG WITH
30 P.P.V.TOTAL 120 EVENTS PER MINUTE
• PATTERN :-TWO PERSON SHOULD BE THERE THREE COMPRESSIONS FOLLOWED BY ONE
VENTILATION
• TIME DURATION :-3 CHEST COMPRESSIONS SHOULD BE DONE WITHIN 1.5 SECOND1 VENTILATION
SHOULD BE DONE WITHIN 0.5 SECONDS
• 4 EVENTS (3 COMPRESSIONS + 1 P.P.V.) NEED 2 SECOND TO BE COMPLETED
• THUS, WITHIN 1 MINUTE, TOTAL 120 EVENTS SHOULD BE COMPLETED.
Medication
• MEDICATION :-
• UMBILICAL VEIN SHOULD BE USED FOR ADMINISTERING MEDICATION.
• NO INTRACARDIAC DRUG SHOULD BE GIVEN.
• SOME OF THE MEDICATIONS CAN BE GIVEN THROUGH E.T. TUBE.
1. EPINEPHRINE DOSE - 0.01 TO 0.03 mg/Kg ROUTE I.V.
2. SODIUM BICARBONATE – 1:1 (WITH WATER)
Complications
• PULMONARY HYPERTENSION
• HYPOTHERMIA
• RIBS FRACTURE
• HYPOXEΜΙΑ
• PNEUMOTHORAX
• HYPOGLYCEMIA
• TACHYAΡΝΕΑ
• HYPERVENTILATION
• HYPOXIC ISCHEMIC ENCEPHALOPATHY

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