Neonatal Resuscitation


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Presentation Transcript

Newborn Resuscitation : 

Newborn Resuscitation Dr Samarnath Sen Staff Grade Paediatrician Doncaster Royal Infirmary

Newborn resuscitation : 

12/02/2010 2 Newborn resuscitation 130 million infants are born every year 10% require some kind of intervention 3% (~4 mill) develop birth asphyxia requiring resuscitation 900,000 of these die each year ~1million develop sequela WHO 1998, AHA 2000 The need for resuscitation is higher in preterm than in term infants

Slide 3: 

12/02/2010 3 Resuscitation of Newborn Infants New Guidelines WHO: Basic Newborn Resuscitation ( WHO, Geneva 1998) ILCOR: An Advisory Statement From the Pediatric Working Group of the International Liason Committee on Resuscitation.(Pediatrics, April 1999) AHA/AAP: International Guidelines for Neonatal Resuscitation (Pediatrics September 2000)

WHO Guidelines : 

12/02/2010 4 WHO Guidelines Risk factors for birth asphyxia Maternal illness Traumatic delivery STD Prolapsed cord Malaria Mec stained liquor Eclampsia Congenital anomaly Maternal bleeding Prolonged labour Maternal sedation Breech/abn presentation Fever during labour PROM

WHO Guidelines : 

12/02/2010 5 WHO Guidelines Anticipate Be prepared for every birth by having skill to resuscitate and by knowing the institutions policy on resuscitation Review the risk factors for birth asphyxia Clearly decide on the responsibilities of each health care provider during resuscitation Remember that the mother is also at risk of complications

Apnoea : 

12/02/2010 6 Apnoea Primary Apnoea Secondary Apnoea Because after delivery of an infant it is impossible to differentiate between primary apnoea and secondary apnoea, assume the infant is in secondary apnoea and begin resuscitation immediately.

Slide 7: 

12/02/2010 7

Neonatal Resuscitation : 

12/02/2010 8 Neonatal Resuscitation Four Categories Basic steps including rapid assessments and initial steps of stabilisation Ventilation, including bag-mask or bag -tube ventilation Chest compression Administration of medications or fluids

Slide 9: 

12/02/2010 9

Initial Steps for Neonatal Resuscitation in Delivery Room : 

12/02/2010 10 Initial Steps for Neonatal Resuscitation in Delivery Room A. Warm & Dry infant Place infant under radiant heat warmer bed and dry infant (tactile stimuli) .This helps prevent cold stress. B. Initiate ABC A= Establish airway: position head in neutral position and bulb sx mouth and nose. B= Breathing : Bag & Mask Ventilation or Bag & Et tube always with 100% FI02. C= Circulation: Assess heart rate by listening to Apical pulse with stethoscope, pulse in umbilicus, or brachial pulse. C. Evaluate infant for: 1. Colour: central vs. acrocyanosis. If centrally cyanotic give infant facial oxygen. 2. Signs of Respiratory distress: a. Increased WOB b. Nasal flaring c. Tachypnoea d. Grunting

Bag and Mask Ventilation in the Newborn : 

12/02/2010 11 Bag and Mask Ventilation in the Newborn Indications for bag mask ventilation a. Apnoea b. Heart rate less than 100 Pressure used a. Initial breath after delivery = 30-40 cm H20 b. Normal delivery = 15-20 cm H20 c. Diseased Lungs = 20-40 cm H20 5. Technique/Troubleshooting problems of Bag mask ventilation a. Check for a good seal b. Check for a patent airway c. Are you using enough pressure ?

Intubation of the Neonate : 

12/02/2010 12 Intubation of the Neonate Indications for intubation a. Prolonged bag and mask ventilation b. Bag and mask is ineffective c. Tracheal suctioning ET tube sizes and correct suction catheter sizes: Weight of Infant ET tube Size Suction catheter size < 1000 gms 2.5 Et tube 5-6 french suction catheter 1000-2000 gms 3.0 Et tube 6 french suction catheter 2000-3000 gms 3.5 Et tube 8 french suction catheter >3000 gms 4.0 Et tube 8 french suction catheter

Chest Compressions : 

12/02/2010 13 Chest Compressions Indications: If after 15-30 seconds of positive pressure ventilation with 100% FI02 the heart rate is a. below 60 b. between 60-80 and not increasing Technique: a. 1 fingers breadth below nipple line, using 2 fingers b. 1/2 to 3/4 compression depth c. accompanied by ventilations, ratio is 3:1

Medications : 

12/02/2010 14 Medications Indications for Medications: If infants heart rate remains below 60 beats per minute despite adequate ventilation ( with 100%), and chest compressions for a minimum of 30 secs or HR = 0 . Epinephrine: Increases the rate and strength of cardiac contractions and causes peripheral vasoconstriction. Volume expanders are for hypovolaemic states: Signs of hypovolaemia include pallor despite oxygenation, weak pulses with a good heart rate, poor response to resuscitative efforts, decreased blood pressure ( may not be available). Naloxone Hydrochloride (Narcan): given if there is severe respiratory depression and a history of maternal narcotic administration within the past 4 hours. Sodium Bicarbonate: helps correct metabolic acidosis, indicated when there is a prolonged arrest that does no respond to other therapy. Because it is a hyperosmotic solution, give slowly in order to minimize the risk of intraventricular haemorrhage.

WHO Guidelines : 

12/02/2010 15 WHO Guidelines Resuscitation practises not effective or even harmful routine aspiration of babies mouth and nose routine aspiration of stomach stimulation by slapping or flicking the soles of its feet postural drainage or slapping the back squeezing the chest to remove secretions routine giving sodium bicarbonate to newborns who are not breathing

WHO Guidelines : 

12/02/2010 16 WHO Guidelines Care after successful resuscitation do not separate mother and newborn- skin-to skin examine the newborn (body temp, count breaths, observe indrawing and grunting, malformations, etc) record the resuscitation and the problems.

Newborn ResuscitationAHA/AAP Guidelines : 

12/02/2010 17 Newborn ResuscitationAHA/AAP Guidelines Meconium stained amniotic fluid: Endotracheal suctioning of the depressed - not the vigorous child Hyperthermia should be avoided Chest compression: Initiated if heart rate is absent or remains < 60 bpm despite adequate ventilation for 30 sec Medications: Epinephrine 0.01-0.03 mg/kg if heart rate < 60 bpm in spite of 30 seconds adequate ventilation and chest compression Volume: Isotonic crystalloid solution or 0-neg blood Summary of changes from 1992



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