Newborn Resuscitation By Abhishek Jaguessar
Transcript of Newborn Resuscitation By Abhishek Jaguessar
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BY
ABHISHEK JAGUESSAR
NEWBORN
RESUSCITATION
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birth asphyxia is defined
simply as the failure toinitiate and sustain
breathing at birthThe common worry of health
professionals and parents is thepermanent brain damage that
birth asphyxia can cause.
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Management of baby
with birth asphyxia
1)Basic Resuscitation
2)Advanced Resuscitation
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BASIC
RESUSCITATION
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ABCs of Resuscitation
A - establish open airway
Position, suction
B - initiate breathingTactile stimulation
Oxygen
C - maintain circulation
Chest compressions
Medications
A B C (A: Airway, B: Breathing, C: Circulation)
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Basic Resuscitation
Initial steps:
Thermal management
Positioning
SuctioningTactile stimulation
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1.Anticipation.
2.Adequate preparation.3.Timely recognition.
4.Quick and correct action
are critical for the successof resuscitation
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Resuscitation must be
anticipated at every birth.Every birth attendant should
be prepared and able to
resuscitate
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Good management ofpregnancy and
labour/deliverycomplications
is the best means ofpreventing birth asphyxia
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For resuscitation:1. A self-inflating Ambou bag (newborn size)
2. Two infant masks (for normal and smallnewborn),
3. A suction device (mucus extractor),
4. A radiant heater (if available), warm towels, ablanket and
5. A clock
are needed
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1.Prevention ofheat loss,
2.Opening the airway and
3.Positive pressure ventilation
that starts within the first minute
of life
The important steps in
resuscitation are:
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The surface on whichthe baby is placed
should always be
warm as well as flat,firm and clean
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This consists of :
drying,positioning the neonate under
radiant warmer to minimize heat lossand suctioningof mouth and nose
(Tracheal suctioning if meconium
present).
This should only take approximately
20 seconds
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provides sufficient
stimulation of breathingin mildly depressed
newborns and no furtherstimulation is appropriate
Drying
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The second step
(within 20-30 seconds of birth)is assessment of neonatal
respiration
If the newborn is crying and
breathing is normal,
no resuscitation is needed
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The upper airway
(the mouth then the
nose)should besuctioned to remove
fluid if stained with
blood or meconium
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if the chest is rising
symmetrically with frequency
>30/minute,
no immediate action is
needed
If there is no cry,
assess breathing:
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If the newborn is not
breathing or gasping:
immediately startresuscitation.
Occasional gasps are not
considered breathin .
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Open the airway
Put the baby on its backPosition the head so that
it is slightly extended .
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for ensuring adequate ventilation
of the lungs, oxygenation of vitalorgans, and initiation of
spontaneous breathing.
The most important aspect of
newborn resuscitation
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Ventilation can almost
always be initiated using a
bag and mask and roomair.
(it is rarely necessary tointubate)
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When no equipmentis available:
mouth to mouth-and-
nose breathingshould be done.
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Adequacy ofventilation is
assessed by
observing the
chest movements
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Ventilate
Select the appropriate mask
Reposition the newbornMake sure that the neck is slightlyextended.
Place the mask on the newborn'sface, so that it covers the chin,
mouth and nose .
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Form a seal between the
mask and the infant's face.
Squeeze the bag with twofingers only or with the
whole hand, depending onthe size of the bag
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After effectively ventilating for
about 1 minute, stop briefly but do
not remove the mask and bag and
look for spontaneous breathingIf there is none or it is weak,
continue ventilating untilspontaneous cry/breathing begins.
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If the newborn startscrying:
stop ventilating but
do not leave thenewborn.
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If breathing is slow
(frequency of breathing is
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A newborn will benefitfrom transfer only if it is
properly ventilated and
kept warm duringtransport
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Stop ventilation
If there is no gasping or
breathing at all after 20
minutes of ventilation:
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Do not separate themother and the newborn.
Leave the newborn skin-to-skin with the mother
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Encourage breast-feeding within
one hour of birth.The newborn that needs
resuscitation is at higher risk ofdeveloping hypoglycaemia.
Observe suckling .
Good suckling is a sign of
good recovery
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Risk factors are poor
predictors of birth asphyxia.
Up to half of newborns who
require resuscitation have no
identifiable risk factors
before birth.
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Taking an Apgar score is
not a prerequisite forresuscitation.
The need for resuscitationmust be recognized before the
end of the first minute of lifewhich is when the first Apgar
score is taken
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Sign 0 1 2
Heart rate Absent 100
beats/min
Respirations Absent Weak cry Strong cry
Muscle tone Limp Some flexion Active motion
Reflex No response Grimace Activewithdrawal
Color Blue, pale Body: pink
Extremities:
blue
Completely
pink
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ADVANCED
RESUSCITATION
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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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This has been shown to provide
more effective ventilation in
severely depressed/ill newborns. It is more convenient for
prolonged resuscitation but is alsoa more complicated procedure
that requires good training.
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OxygenAdditional oxygen is not
necessary for basic resuscitation ,
although it has been considered
so by some practitioners.
Oxygen is not available at all
places and at all times.
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Moreover, new evidencefrom a controlled trial
shows that :most newborns can be
successfully resuscitatedwithout additional oxygen.
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However, when the
newborn's color does not
improve despite effectiveventilation,
oxygen should be givenif available.
A i d t ti f
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1.Meconium aspiration and
2.Immature lung, or3.When the baby does not
become pink despite adequateventilation.
An increased concentration of
oxygen is needed for:
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Chest compressions are not
recommended for basic
newborn resuscitation.
There is no need to assess
the heartbeat before starting
ventilation
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Compressions should be
administered if the heart
rate is absent or remains
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The (2-thumb, encircling-hands
method) of chest compression ispreferred, with a depth of
compression one third theanterior-posterior diameter of
the chest and sufficient togenerate a palpable pulse.
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In newborns with persistent
bradycardia (heart rate
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A higher mean arterial
pressure was observed usingthe method in which the
hands encircle the chestcompared to the two-finger
method of compressing thesternum.
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Two people are needed for
effective chest compressionand ventilation.
Before the decision is takenthat chest compressions are
necessary, the heart rate mustbe assessed correctly.
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1.Stimulate the heart.2.Increase tissue perfusion
3.Restore acid-base balance.
Drugs are seldom needed to:
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They may be required in
newborns who do not
respond to adequate
ventilation with 100%
oxygen and chestcompressions.
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Narcotic antagonists
and plasma
expanders havelimited indications
in newbornresuscitation
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Sodium bicarbonate is not
recommended in theimmediate postnatal period
if there is no documentedmetabolic acidosis.
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It should therefore
not be given routinelyto newborns who are
not breathing
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Epinephrine in a dose of0.01-0.03
mg/kg (0.1-0.3 mL/kg of 1:10,000
solution) should be administered ifthe heart rate remains
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Emergency volume expansionmay be accomplished with an
isotonic crystalloid solution or O-negative red blood cells; albumin-
containing solutions are no longerthe fluid of choice for initial
volume expansion
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can serve as an alternative
route for medications/volumeexpansion if umbilical or
other direct venous access isnot readily available.
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