NEONATAL RESUSCITATION

Rachel Musoke University of Nairobi

KNH/UON SYMPOSIUM 10TH Jan 2013

Poor intrapartum fetal oxygenation

• Also referred as asphyxia• Common cause of death & long term disability

(mental & neurological)• Estimated to contribute to 9% of all < 5

mortality (MDG 4)• Burden of disease assessment – 42 million

disability-adjusted life years (DALYs)

Contributing factors

The delays• Delay in recognition of the problem in the

mother• Delay in transportation to a medical facility• Delay in providing appropriate care at the

health facility

Solutions to reduce deaths & disability

• Primary prevention – maternal care (early recognition & management)

• Secondary prevention – appropriate neonatal resuscitation

• Tertiary prevention – recognition & management of acute complications

The Global Need for neonatal Resuscitation, FIGO, Wall et al

Which babies need resuscitation?

Assess: • Gestation – term or preterm?• Breathing or Crying?• Good tone?• If NO then act quickly

–The first “golden minute”

The ABC of resuscitation

• Airway (Position and clear)• Breathing (stimulate to breathe)• Circulation (Majority of babies have normal

hearts)

• Warmth

Breathing

• Ventilation of baby’s lungs is the most important and effective action in neonatal resuscitation

Room air vs.O2 for Resuscitation

Term InfantsPre-Term Infants

(< 32 weeks)

Room air or oxygen?

Term infants: Mortality lower with room air vs 100% O2

Shorter recovery

PretermBalance the needs for oxygen vs possible toxicity

Oxygen saturations at birth

1 minute 60-65%

2 minutes 65-70%

3 minutes 70-75%

4 minutes 75-80%

5 minutes 80-85%

10 minutes 85-95%

Meconium stained liquor

• Clear mouth & nose before drying & stimulation to avoid aspiration

• Suctioning of the trachea reserved for nonvigorous babies

Equipments

• Warmth towels & heater• Airway – suction catheters• Ventilate – bag (500ml). & masks (sizes)• Source of oxygen (& blender)• Auscultate – stethoscope• Pulse oximeter (if possible)• Intubation equipment

Key behavior skills

• Know your environment• Anticipate & plan• Call for help & work as a team• The person present must initiate

resuscitation• Communicate effectively• Use all available resources

SUMMARY

Effective Resuscitation

Airway & Breathing

Circulation

Drugs

Summary

• Everybody who conducts a delivery must be able to resuscitate

• We should be prepared at all times

• Lets give our newborn a good start