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
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
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
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 THANK YOU FOR YOUR LISTENING : 12/02/2010 18 THANK YOU FOR YOUR LISTENING