Chapter3Problems of the neonate and

young infant -Neonatal resuscitation

Case study: Chan

Baby Chan is born at term. He is blue and has

poor muscle tone. He doesn't cry.

Routine care of the newborn at delivery

Dry baby with clean cloth and place where the baby will be warm

Look for:

Breathing or crying

Good muscle tone

Colour pink

Start the resuscitation now!

NO

NO

NO

Neonatal resuscitation (A)

• Open airway by positioning the head in the neutral position (Ref. p. 47)

• Clear airway, if necessary

• Stimulate, reposition

• Give oxygen, as necessary

Baby Chan is still blue and not breathing.

Neonatal resuscitation (B)

• Use a correctly fitting mask:

• Observe the baby closely!

• Give the baby 5 slow ventilations with bag (Ref. p. 47-49)

Neonatal resuscitation (C)• Baby Chan starts breathing

• But if the baby is still not breathing (Ref. p. 47) :Check position and mask fit:

Check the heart rate Continue to bag at rate of about 40 breaths per minuteUse oxygen if availableEvery 1-2 minutes stop and see if the pulse or breathing has improved.

History

Baby Chan was born at term. He came out not crying, blue and with poor muscle tone. He was reanimated for 2 minutes.

Rupture of membranes happened at home, contractions were regular. His mother was in labour for a long period of time, but progressed to normal delivery in hospital. No chronic illness and no pre-eclampsia were diagnosed before. Chan is her first baby.

Examination after stabilisation

After 2 minutes resuscitation baby Chan was breathing normally, muscle tone has increased. He was crying. Vital signs: pulse: 140/min, RR: 50/minWeight: 3,2 kgChest: air entry was good bilaterally and there were no added sounds, no chest indrawing was noticedCardiovascular: both heart sounds were audible and there was no murmurAbdomen: soft, bowel sounds were activeNeurology: muscle tone middle, no focal signs

What supportive care and monitoring are required?

Monitoring

• The newborn has to be monitored frequently• Pay attention to child's breathing, muscle tone

and ability to drink

Monitoring (continued)

• In the days after birth the newborn may develop following problems (Ref. p. 51-52):

Convulsions check glucose treat with phenobarbital Apnoea oxygen by nasal catheter resuscitation with bag and mask Inability to suck feed with milk via a nasogastric tube

Treat only if the problems arise

Supportive Care

• If none of the problems described arise provide supportive care as for the normal newborn:– Give the baby to mother as soon as possible,

place on chest or abdomen– Cover the baby to prevent heat loss– Encourage initiation of breastfeeding within

the first hour– Keep umbilical cord clean and dry– Give vitamin K (phytomenadione), according

to national guidelines 1 ampoule IM once– Apply antiseptic ointment or antibiotic eye

drops (e.g. tetracycline) to both eyes once (prophylaxis), according to national guidelines(Ref. p. 46, p. 50)

Breastfeeding support

Early and exclusive breastfeeding is very important for all newborns.

Breastfeeding support:

• Encouragement• Breastfeeding friendly environment• Breastfeeding, assessment and counselling

(Ref. p. 295)

Progress

Chan's motor tone has recovered well. After his mother was encouraged and counselled in breastfeeding, he started to suck. After some difficulties at the beginning he was sucking well. Before he was discharged home he also received oral polio, hepatitis B and BCG vaccines.

Follow-up

Baby Chan should receive regular clinical follow-up at first-level facilities to monitor:– His clinical condition– Growth– Nutritional intake– Immunization status

Summary

• Be prepared for resuscitation at every delivery.

• Learn all steps of neonatal resuscitation by heart and train them whenever it is possible.

• Prognosis for the baby with perinatal asphyxia can be predicted by recovery of motor function and sucking ability. The prognosis is good for babies who respond quick to resuscitation. It is worse, if the baby has not recovered motor function and cannot suck spontaneously.