NEONATAL RESUSCITATION

BY DR SHANZA AUROOJ

WHAT IS NEONATAL RESUSCITATION?Neonatal Resuscitation is

intervention after a baby is born to help it breathe and to help its heart beat.

Before a baby is born, the placenta provides

oxygen and nutrition to the blood and removes

carbon dioxide.

After a baby is born, the lungs provide

oxygen to the blood and remove carbon

dioxide

The transition from using the placenta to using the lungs for gas exchange begins when the umbilical cord is

clamped or tied off, and the baby has its first breath.

Many babies go through this transition without needing intervention.

Some babies need help with establishing their air flow, breathing, or circulation

Neonatal resuscitation is helping the newborn with

AIRWAY BREATHING CIRCULATION

ABC

PREPARATION FOR RESUSCITATION

ANTICIPATIONADEQUATE EQUIPMENTADEQUATE PERSONNEL

EQUIPMENT REQUIREDRESUSCITATION TABLESTERILE LINENSUCTION APPARATUSLARYNGOSCOPEAMBU BAG & FACE MASKSORAL AIRWAYSOXYGEN WITH FLOW METER & TUBINGENDOTRACHEAL TUBESSCISSORS GLOVES

MEDICATIONSEpinephrineNaloxone hydrochlorideVolume expanders

Normal saline Albumin 5% Ringer lactate

Sodium bicarbonate4.2%Dextrose water 10%Sterile water

MISCELLENOUS Radiant warmer Stethoscope Adhesive tape Syringes Butterfly needles Umbilical artery catheterization tray Umbilical catheter 3 & 5 fr Feeding tube Spirit sponges

RADIANT WARMER

AMBU BAG

Newborn life support

Clear of meconiumBreathing or crying?Good muscle tone?Color pink?Term gestation?

Provide warmthPosition (clear airway)Dry,stimulate,repositionGive Oxygen

Evaluate respiration,heart rate & colour

Routine care:•Provide warmth •Clear airway•dry

Provide positive pressure ventilation

Provide positive pressure ventilationAdminister chest compression

Administer adrenaline

Supportive care

Ongoing care

BIRTH

YES

NO

Breathing HR>100 & PINK

APNEA Or HR<100

VENTILATING

HR>100 & PINK HR<60 HR>60

HR<60 HR>60

HOW TO PREVENT HEAT LOSS?

Place the infant under radiant heat source

Dry off the amniotic fluid

What is the correct position?How to clear airway?

Place the newborn in a supine position with neck semi extended,use a shoulder role to keep neck extended

Suction the infant’s mouth and nose

A=AIRWAY

INITIATE BREATHINGUse tactile stimulationEmploy positive pressure

ventilation when necessary usingBag & maskBag & endotracheal tube

Ventilation rate=40/minVentilation pressure=15-

20cm of water Continue ventilation for

15-30 minutes

B=BREATHING

WHAT ARE THE WAYS TO MAINTAIN CIRCULATION?Chest compression=when

HR<60/minSternum should be compressed ½

inch with PPV at the ratio of 3: 1 Encircle the chest with overlapping

thumbs orPlace middle & index finger of one

hand right angle to the chest wall over sternum

Continue for 30 seconds,if HR>60 & increasing stop compressions

C=CIRCULATION

When to use medication?

When HR is not increasing despite adequate ventilation with 100% oxygen & chest compression then use drugs to stimulate heart

ADRENALINE(1:10,000): 0.1-0.3 ml/kg IV, repeated every 3-5 min

Volume expanders(N/S,R/L,5% albumin): 10 ml/kg IV 5-10/min

Sodium bicarbonate:prolonged cardiac arrest 1-2 meq/kg IV

Naloxone hydrchloride: 0.1 mg/k IV,maternal narcotics administration within 4 hours

Dopamine: continued shock,dose=5-20 mg/kg/min,continous

THANKYOU