Post on 09-Apr-2018
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NEWBORN
RESUSCITATION
(NEWBORN CPR)BSN 12C
MADELINE N. GERZON, RN, MM
Clinical Instructor
Davao Doctors College
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Objectives
By the end of this session, students will be able
to:
1. Define Newborn CPR
2. Determine conditions of mother that warrant
newborn CPR immediately after delivery
3. Distinguish newborn that requires CPR(resuscitation) through careful assessment
4. Identify equipment to perform newborn CPR
2
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Objectives
By the end of this session, students will be
able to:
5. Familiarize the skills in newborn CPR
(resuscitation)
6. Discuss relevant nursing responsibilities
during newborn CPR
3
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WHAT IS NEWBORN CPR?
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Newborn CPR/Resuscitation
Is an intervention after a baby is born to
help the baby breathe and to help
his/her heart beat.
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Newborn Resuscitation Algorithm
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Newborn Resuscitation Algorithm
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Newborn Resuscitation Algorithm
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BASIC
RESUSCITATION
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CRITICIAL THINKING
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1.Anticipation
2.Adequate preparation
3.Timely recognition
4.Quick and correct action
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ANTICIPATION
Resuscitation must be anticipated at
every birth
Every birth attendant should beprepared and able to resuscitate
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Adequate preparation
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Timely recognition
ASSESSMENT
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QUICK AND CORRECT ACTION
Skills in Resuscitation
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IMPORTANT STEPS IN RESUSCITATION
1. Prevention ofheat loss
2. Opening the airway, and
3. Positive pressure ventilation that starts within the
first minute of life
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The surface on which the
baby is placed shouldalways be warm as well
as flat, firm and clean
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Initial stabilization and evaluation..
drying, positioningthe neonate under
radiant warmer to minimize heat loss
and suctioningof mouth and nose(Tracheal suctioning if meconium
present)
This should only take approximately
20 seconds!!!
#1
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DRYING
provides sufficient stimulation of
breathing in mildlydepressed newborns
and no further stimulation is appropriate
What else?
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Stimulate the newborn as requiredby flicking its feet or rubbingits backDO NOT spank orvigorously rub a newborn baby!
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(within 20-30 seconds of birth)
is assessment of neonatal
respiration
If the newborn is crying and
breathing is normal,
no resuscitation is needed
#2
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if the chest is rising symmetrically
with frequency >30/minute, noimmediate action is needed
If there is no cry,
assess breathing!
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If the newborn is notbreathing or gasping:
immediately startresuscitation.
Occasional gasps are not
considered breathing.
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The most important aspect ofThe most important aspect of
newborn resuscitationnewborn resuscitation
Positive pressure ventilation
#3
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What is Positive Pressure Ventilation?
higher than atmospheric pressure
pushes air into the lungs
Administered either noninvasively vianasal, facial or oral masks, nasal pillows
(small cushions that fit into the nostrils),
and mouthpieces with tubing attaching
to the ventilator or invasively via
tracheostomy
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Rationale
To ensure adequate ventilation of the
lungs, oxygenation of vital organs, and
initiation of spontaneous breathing
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How?
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Ventilation can almost always be
initiated using a bag and mask
and room air
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When no equipment is available:
mouth to mouth-and-nose
breathingshould be done.
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Form a seal between the mask and the
infant's face. Squeeze the bag with two
fingers only or with the whole hand,
depending on the size of the bag
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Ventilate with 100% oxygen
for 1530 seconds.
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Adequacy of ventilation is
assessed by observing thechest movements
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After effectively ventilating for
about 1 minute, stop briefly but do
not remove the mask and bag andlook for spontaneous breathing
If there is none or it is weak,continue ventilating until
spontaneous cry/breathing begins
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If the newborn starts crying:
stop ventilating but do not leave
the newborn.
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If breathing is slow (frequency
of breathing is
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A newborn will benefit from
transfer onlyif it is properly
ventilated and kept warm duringtransport
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If there is no gasping or breathing at all
after20 minutes of ventilation: Stop
ventilation
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Care after successful resuscitation
Do not separate the mother and
the newborn.
Leave the newborn skin-to-skin
with the mother
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Care after successful resuscitation
Encourage breastfeeding within
one hour of birth.
The newborn that needs
resuscitation is at higher risk of
developing hypoglycemia. Observe suckling (why?)
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Good suckling is a signofgood recovery.
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REMEMBER!!!
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Assessment and timely recognition of
the problem..
Risk factors are poor predictors of birth
asphyxia.
Up to half of newborns who requireresuscitation have no identifiable risk
factors before birth.
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Assessment and timely recognition of
the problem..
Taking an Apgar score is not a
prerequisite for resuscitation.
The need for resuscitation must berecognized before the end of the first
minute of life which is when the first
Apgar score is taken
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ADVANCEDADVANCEDRESUSCITATIONRESUSCITATION
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A small proportion of infants fail to respond toventilation with the bag and mask.
This happens infrequently but, when it does,
additional actions must be taken.
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Endotracheal Intubation
This has shown to provide more effective ventilation
in severely depressed/ill newborns.
It is more convenient for prolonged resuscitation but
is also a more complicated procedure that requiresgood training.
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Moreover, new evidence from a
controlled trial shows that most
newborns can be successfullyresuscitated without additional
oxygen
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However, when the newborn's color does not
improve despite effective ventilation, oxygen should
be given if available.
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An increased concentration of oxygen is
needed for:
1. Meconium aspiration
2. Immature lung, or
3. When the baby does not become pink despite
adequate ventilation.
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Chest Compressions
Chest compressions are not recommended for basic
newborn resuscitation.
There is no need to assess the heartbeat before
starting ventilation.
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Chest Compressions
Compressions should be administered if the heart
rate is absent or remains
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Chest Compressions
The (2-thumb, encircling-hands method) of chest
compression is preferred, with a depth of
compression one third the anterior-posterior diameter
of the chest and sufficient to generate a palpable
pulse
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Chest Compressions
In newborns with persistent bradycardia (heart rate
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Chest Compressions
y A higher mean arterial pressure was observed using
the method in which the hands encircle the chest
compared to the two-finger method of compressing
the sternum.
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Chest Compressions
Two people are needed for effective chest
compression and ventilation.
Before the decision is taken that chest compressions
are necessary, the heart rate must be assessed
correctly.