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Transcript of Neonatal Resuscitation ALSO(UK) wish to thank Dr S Richmond for this talk and fully acknowledge the...
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Neonatal Resuscitation
Neonatal Resuscitation
ALSO(UK) wish to thank Dr S Richmond for this talk and fully acknowledge the use of material copyright the northern Neonatal
Network, the Resuscitation Council (UK) and the Newborn Life Support course
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ObjectivesObjectives
• Select and properly use equipment for neonatal resuscitation
• Perform rapid evaluation of the newborn
• Describe resuscitation schemes and algorithms
• Describe the management of meconium
• Describe the management of the early neonatal period and the most common complications
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Stimuli for the first breathStimuli for the first breath
• Cord obstruction
• Cold air
• Physical discomfort
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First breathsFirst breaths
Push fluid from airway& alveoli into pulmonary
lymphatics
Push fluid from airway& alveoli into pulmonary
lymphatics
Establishesresting lung volume
Establishesresting lung volume
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Sustained (2 second) Inflation BreathsSustained (2 second) Inflation Breaths
First
Breaths
Arterioles Dilate and Blood Flow Increases
Third
Second
Fetal LungFluid
Air
O2
O2 O2
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Resuscitation EquipmentResuscitation Equipment
YOU CAN SUCCESSFULLY RESUSCITATE WITH THE FOLLOWING MINIMUM EQUIPMENT &
SKILLS: • Towels to dry and wrap
• Appropriate-sized face mask
• 500ml ventilation bag
• Firm, stable surface (possibly the floor)
• Ability to ventilate appropriately
• Ability to perform cardiac massage
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‘Ideal’ Additional Equipment‘Ideal’ Additional Equipment
ClockGas supply and blow off valveGuedel airwaysLaryngoscope & Endotracheal tubesLightingDrugs - Sodium Bicarbonate - Adrenaline - Dextrose - (Volume)Wide-bore suckerScissors and tape
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• Dry & cover the baby• Assess the situation• Airway• Breathing - Inflation breaths• Chest compressions• (Drugs)
Basic steps in resuscitationBasic steps in resuscitation
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Initial actionsInitial actions
• Start the clock • Dry the baby • Assess
Do you need help ?
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Initial assessmentInitial assessment
• Colour
• Tone
• Breathing
• Heart rate
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Condition – Group 1Condition – Group 1
• Blue Pink
• Good tone
• Breathing regularly
• Fast heart rate
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Dry and coverGive to Mum
Dry and coverGive to Mum
• Blue Pink
• Good tone
• Breathing regularly
• Fast heart rate
ManagementManagement
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• Blue
• Moderate tone
• Breathing inadequately
• Slow heart rate
Condition – Group 2Condition – Group 2
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• Blue
• Moderate tone
• Breathing inadequately
• Slow heart rate
ManagementManagement
Dry and coverOpen the airwayInflation breaths
Dry and coverOpen the airwayInflation breaths
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• Blue or white
• ‘Floppy’
• Not breathing
• Slow or very slow heart rate
Condition – Group 3Condition – Group 3
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• Blue or white
• ‘Floppy’• Not breathing
• Slow or very slow heart rate
ManagementManagement
Dry and coverOpen the airwayInflation breathsRe-assessDo you need help ?
Dry and coverOpen the airwayInflation breathsRe-assessDo you need help ?
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Neonatal Position for Opening the Airway – ‘neutral position’
Neonatal Position for Opening the Airway – ‘neutral position’
Incorrect: Neck Hyperextension
Incorrect: Neck Under Extended
Correct: Neck Slightly Extended
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Head flexed by large occiputHead flexed by large occiput
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Head in neutral or ‘sniffing’ positionHead in neutral or ‘sniffing’ position
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Jaw falling back – obstructing airwayJaw falling back – obstructing airway
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‘Jaw thrust’ applied – in neutral position‘Jaw thrust’ applied – in neutral position
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• Open the airway - place the child in the neutral position
• If necessary, provide jaw thrust
• Give FIVE initial inflation breaths
Airway ManagementAirway Management
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Inflation breathsInflation breaths
Five breaths,each sustained for 2-3 seconds
at 30 cms of water pressure
Five breaths,each sustained for 2-3 seconds
at 30 cms of water pressure
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• The heart rate will usually respond to lung inflation
• If there is no heart rate response check for chest movement
Inflation breathsInflation breaths
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• Airway reassess
• Breathing reassess - is there a response
?
• Chest compressions reassess
• Drugs
Further resuscitationFurther resuscitation
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• If the chest is not moving, it is not being inflated
• Check A & B
• Do not start chest compressions until the chest is being inflated
Chest compressionsChest compressions
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ReassessReassess
• If the heart rate is slow and not improving
• Consider chest compressions
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Chest (cardiac) compressionsChest (cardiac) compressions
“Two-thumb” technique is usually preferred
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• Indicated when HR < 60bpm after 30 seconds of effective ventilation
• 3:1 compressions:breaths at HR approx 100bpm (Note: EFFECTIVENESS IS MORE IMPORTANT THAN RATE!!!)
• Re-evaluate HR every 30 seconds
• Continue cardiac compressions until HR rising and approx 100bpm (Note: HR USUALLY RESPONDS RAPIDLY)
Chest (cardiac) compressionsChest (cardiac) compressions
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Chest (cardiac) compressionsChest (cardiac) compressions
You only need to move oxygenated bloodfrom the lungs to the coronary arteries
Its not that far and won’t take long!
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ReassessReassess
• Has the heart rate improved ? No
• Re-check airway• Check chest movement• Check compressions
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• Sodium bicarbonate
• Adrenaline
• Dextrose
• (Volume - rarely)
Consider drugsConsider drugs
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• Preterm babies care with inflation pressures
• Meconium see next slide
• Congenital abnormality eg diaphragmatic hernia - may make resuscitation extremely difficult
• Delivery outside labour ward cold babies are more difficult to
resuscitate
Special CasesSpecial Cases
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MeconiumMeconium
• Suction ONLY IF ‘SOLID’ MECONIUM causing physical block to ventilation use catheter or endotracheal tube with wall suction
• Vigorous infant tracheal suction NOT indicated
• Infant with absent/depressed respirations, HR < 100bpm or poor tone if bag ventilation is inadequate, intubate with 10F
catheter to clear SOLID meconium below cords
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• Dry & cover the baby• Assess the situation• Airway• Breathing - Inflation breaths• Chest compressions• (Drugs)
summary neonatal resuscitation summary neonatal resuscitation
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Neonatal mortalityNeonatal mortality
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Causes of neonatal mortality Causes of neonatal mortality
• Preterm birth
• Asfyxia
• Neonatal sepsis
60-80% of neonatal deaths happen in
low birth weight infants (<2000 gr.)
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Preventing neonatal mortalityPreventing neonatal mortality
• All well-responding newborns should be given to their mother immediately after birth and start breastfeeding as soon as possible.
• Skin to skin contact with the mother is the best way of keeping the newborn warm.
• Breastfeeding helps inflate the lungs of the newborn (and prevents the mother from having PPH).
• Do not suction the ventricle
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Managing preterm birthsManaging preterm births
• If gestational age below 34 weeks the mother should have corticosteroids:
• Betametazone 12 mg IM twice 24 hours apart
• Reduces risk of perinatal death 68%
• Reduces risk of Respiratory distress syndrome 66%
• Reduces risk of intra-cerebral haemorrhage 54%
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Managing preterm or low birth weight neonatesManaging preterm or low birth weight neonates
Kangaroo Mother Care (KMC)
• Early, continuous and prolonged skin-to-skin contact between the mother and the baby
• Exclusive breastfeeding
• Initiated in hospital and can be continued at home
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Kangaroo mother careKangaroo mother care
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Kangaroo mother careKangaroo mother care
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Kangaroo mother careKangaroo mother care
Breastfeeding:
preferably mothers milk: if not directly then by cup
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Kangaroo mother careKangaroo mother care
Expressing breast milk:
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Kangaroo mother careKangaroo mother care
Expressing breast milk:
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Kangaroo mother careKangaroo mother care
Breastfeeding:
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AsfyxiaAsfyxia
• Early feeding
• Thermal regulation (KMC / SSC)
• Close observation (at risk for sepsis)
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Neonatal sepsisNeonatal sepsis
Risk factors:
• Unhygienic procedures
• Prolonged rupture of membranes >24 hours
• PPROM
• Preterm birth
• Asfyxia
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Neonatal sepsisNeonatal sepsis
Signs:
• Unable to breastfeed
• Lethargic or unconscious
• Fast breathing
• Severe chest indrawing
• Grunting
• Fever
• Hypothermia
• Umbilical discharge and redness of surrounding skin
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Neonatal sepsisNeonatal sepsis
Treatment:
Early feeding
Antibiotics:
• Ampicillin (or penicillin) 25 mg/kg. IV each 6 hours
• Gentamycin 3 mg/kg IV each 12 hours
• Consider antimalarial treatment
Close observation
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