Presentation Transcript
The New NRP Algorithm: The New NRP Algorithm NRP 2006 – Central Canada Launch
Toronto, ON
Objectives: Objectives Show the new 2006 Resuscitation algorithm
Discuss the NRP 2006 Initial Steps
What has changed since NRP 2000
How specific Canadian Expert Committee recommendations affect the algorithm
The Canadian Expert Committee: National guidelines to neonatal resuscitation across several continents are based on the consensus statements of the International Liaison Committee on Resuscitation (ILCOR).
Each country is expected to develop guidelines that reflect their own context. The Canadian Expert Committee
Other documents: Adapted algorithm
Adapted performance checklists
…. Educational aids?
…. Slides?
…. Other? Other documents
Objectives: Objectives The Initial Steps
Decide if resuscitation is needed
Provide initial steps of resuscitation
Decide if / when oxygen should be given
Exception to “dry the baby”
Resuscitate a newborn when meconium is present
Is resuscitation needed?: Is resuscitation needed? Routine Care
Is resuscitation needed?: Is resuscitation needed? Routine Care NRP 2000 Routine Care NRP 2006
Is resuscitation needed?: Is resuscitation needed? Routine Care NRP 2006 Oxygen is gone …
Routine Care: Routine Care NRP 2006 NRP 2000
Normal transition: Gestational age 37.7
Birth weight 3036g
SpO2 >75% 207 s
SpO2 >90% 343 s . Kamlin, O'Donnell, Davis, Morley. SPR 2005. A2050 Normal transition Slide courtesy of ACoRN 2006 ACoRN © 2006
Slide12: Normal transition Rabi Y, Yee W, Chen SY, Singhal N. J Pediatrics 2006 148( 5):590-594 Slide courtesy of ACoRN 2006 ACoRN © 2006
Slide13: Rabi Y, Yee W, Chen SY, Singhal N. J Pediatrics 2006 148( 5):590-594 Normal transition Slide courtesy of ACoRN 2006 ACoRN © 2006
Slide14: Rabi Y, Yee W, Chen SY, Singhal N. J Pediatrics 2006 148( 5):590-594 Normal transition Slide courtesy of ACoRN 2006 ACoRN © 2006
Canadian Expert Committee: Canadian Expert Committee “Oxygen should be administered to babies who remain cyanotic at 90 seconds of age”
Routine Care: Routine Care NRP 2006
Routine Care: Routine Care NRP 2006 NRP 2000
Routine Care: Routine Care NRP 2006 What if this “well baby” baby remains cyanotic > 90 sec?
NRP algorithm: Routine Care NRP algorithm Wait 90 seconds
The initial steps: The initial steps 2006
The initial steps: 2000 2006 The initial steps
The initial steps: 2006 … no oxygen given The initial steps Exception to “dry the baby”
NRP algorithm: Routine Care NRP algorithm
NRP algorithm: Routine Care NRP algorithm
NRP algorithm: Routine Care First 30 seconds NRP algorithm Wait 90 seconds
NRP algorithm: Observational Care Routine Care First 30 seconds NRP algorithm
NRP algorithm: NRP algorithm Observational Care Routine Care … at 90 seconds First 30 seconds
Open the airway and provide initial steps: Open the airway and provide initial steps Observational Care Routine Care 30 sec
Cyanotic baby “who appears well”: Routine Care Cyanosis at 90 sec Cyanotic baby “who appears well”
Cyanotic baby “who appears well”: Observational Care Routine Care ? Cyanosis at 90 sec Cyanotic baby “who appears well”
Cyanotic baby “who appears well”: Observational Care Routine Care ? Cyanosis at 90 sec Cyanotic baby “who appears well”
Cyanotic baby “who appears well”: Cyanotic baby “who appears well” No line in NRP … to get back to algorithm
AAP: Start oxygen
CPS: Start oxygen at 90 seconds
Baby requires evaluation for further stabilization ...
Cyanotic baby “who appears well”: Observational Care Routine Care ? Stabilization ? Cyanotic baby “who appears well” Cyanosis at 90 sec
The persistently cyanotic baby: The persistently cyanotic baby
Oxygen administration: Oxygen administration Only central cyanosis requires intervention. Acrocyanosis does not indicate hypoxemia.
“If the baby is breathing but appears blue, administration of supplemental oxygen is indicated” at 90 seconds…
“Supplemental oxygen also may be needed when respirations are being assisted” at 90 seconds…
“There is evidence that resuscitation with air is as effective as with 100% oxygen …”
Slide36: Oxygen administration
Slide37: Blending oxygen
Slide38: Blending oxygen
“Dry-exposed” Resuscitation: “Dry-exposed” Resuscitation Gestational Age > 28w
“Dry-exposed” Resuscitation: “Dry-exposed” Resuscitation Gestational Age > 28w
“Wet-in-bag” Resuscitation: “Wet-in-bag” Resuscitation Gestational Age < 28w
“Wet-in-bag” Resuscitation: “Wet-in-bag” Resuscitation Gestational Age < 28w
“Wet-in-bag” Resuscitation: “Wet-in-bag” Resuscitation Gestational Age < 28w
“Wet-in-bag” Resuscitation: “Wet-in-bag” Resuscitation Gestational Age < 28w
“Wet-in-bag” Resuscitation: “Wet-in-bag” Resuscitation Gestational Age < 28w Photo courtesy: BC’s Children’s Hospital NICU
Slide46: “Wet-in-bag” Resuscitation Gestational Age ≤ 28w 88 infants
Infants placed in the polyurethane bags were less likely to have a temp <36.40C on admission
44 vs. 70% (p<0.001)
Better if room at 25-26oC Knobel et al. Heat loss prevention for preterm infants in the delivery room. J Perinat 2005;25:304-308
Slide47: “Wet-in-bag” Resuscitation
Slide48: “Wet-in-bag” Resuscitation
Slide49: “Wet-in-bag” Resuscitation Polyethylene bags significantly reduce the risk of hypothermia in infants <28 weeks on admission to NICU
RR 0.63 (C.I. 0.42-0.93)
NNT 4
“Wet-in-bag” Resuscitation: “Wet-in-bag” Resuscitation Gestational Age < 28w CPS
Maintenance of DR at 25 to 26oC will diminish heat loss
If GA < 28w place him below the neck in a polyethylene bag
All babies (term/preterm) under radiant warmer by 10 min should have servocontrol probe
The Apgar Score: The Apgar Score
The Apgar Score: The Apgar Score
Slide53: Resuscitation when meconium present
The Initial Steps: The Initial Steps … at 90 seconds Or wet in bag?
Preterm < 32 weeks: Preterm 100 bpm, correct any ventilation problem and use FiO2 1.00.