71107683 neonatal resuscitation
TRANSCRIPT
NEONATAL RESUSCITATION
Dr.(COL) C.G.WILSON
PROFESSOR& H.O.D(PAED)
Dr. K.SATYANARAYANA
CONSULTANT(PAED)
KAMINENI HOSPITALS
PREPARATION FOR
NEONATAL RESUSCITATION
Dr. K.SATYANARAYANA
M.D;
CONSULTANT(PAED)
NEONATAL RESUSCITATION
After delivery most of the babies fall into one of
the 4 groups.
1. Fit and healthy (90-95%)
2. Primary apnoea (5-6%)
• Apnoeic and blue
• Inadequate breathing
• HR : 80 – 100
3. Terminal apnoea (0.2 – 0.5%)
• pale, limp
• apnoeic
• HR < 60
4. Dead but resuscitable ( < 0.1%)
Which baby requires resuscitation ?
• No respiratory effort at all
• Feeble and Inadequate effort
• Vigorous respiratory effort but
cyanosed
• Apnoeic due to primary muscle and
CNS disorder
* Anticipation and preparation are key
factors in the management of resuscitation.
Identification of the high risk neonate:
1. PiH
2. DM
3. Oligohydramnios / Polyhydramnios
4. Multiple pregnancy
5. Rh incompatability
6. Postdated pregnancy
7. APH
8. Abnormal presentations
9. Maternal infections and disorders
10. Meconium stained liquor
11. Prolonged labour
12. Cord prolapse / shoulder dystocia
FACTORS OTHER THAN B.A.
REQUIRING RESUSCIATION
1. PT
2. Maternal hypocapnia
3. Maternal drugs depressing CNS
4. Sepsis (GBS)
5. Anemia
6. Primary muscle and CNS disorder
7. Congential malformations of the
airway and CNS
PRIMARY APNOEA
Shallow respiration
HR & BP Responds to stimulation
Tone and O2 inhalation
SECONDARY APNOEA
HR & BP Requires resuscitation
Flaccid
Primary apnoea and secondary apnoea may occur
even in utero. Apnoea at birth assume it as
secondary apnoea only.
Secondary apnoea and brain damage.
Asphyxia is defined as combn of hypoxemia,
hypercapnia and metabolic acidosis.
Hypoxemia & acidosis
Constriction of arterioles in lungs
Constriction of the PBF, Perfusion
arterioles of other
organs (brain&heart
spared)
Organ damage Oxygenation of tissues
PREPARATION FOR RESUSCIATATION
Personnel:
• 1 person skilled in resuscitation should attend
every delivery
• 2 persons – depressed newborn
• 1 person – Intubation & ventilation
• 2nd person – Monitor HR & chest compressions
• Multiple pregnancy – Separate team for each
infant
NEONATAL RESUSCITATION SUPPLIES
AND EQUIPMENT
Suction equipment:
• Bulb syringe
• Mechanical slow suction (100mm Hg) with
tubing
• Suction catheters, 5F or 6F, 8F and 10F or 12F
• Meconium aspiration device
Bag-and-mask equipment:
• Neonatal resuscitation bag with a pressure-
release valve and / or pressure manometer and
reservoir (the bag must be capable of delivering
90% to 100% oxygen)
• Face masks, newborn and premature sizes
(masks with cushioned rim preferred)
• Oxygen with flow meter (flow rate up to
10L/min and tubing (including portable oxygen
cylinders)
Intubation equipment:
• Laryngoscope with straight blades, No. 0
(preterm) and No.1 (term)
• Extra bulbs and batteries for laryngoscope
• Endotracheal tubes: 2.5, 3.5, and 4.0mm ID
• Styllet (optional)
• Scissors
• Tape for securing tracheal tube
• Laryngeal mask airway (optional)
Umbilical vessel catheterization:
• Sterile gloves
• Scalpel or scissors
• Providone – iodine solution
• Alcohol sponges
• Umbilical tape
• Umbilical catheters: 3.5F, 5F
• Three-way stopcock
• Flushing solution
Miscellaneous:
• Gloves and appropriate personal protection
• Radiant warmer or other heat source
• Firm, padded resuscitation surface
• Clock (timer optional)
• Warmed linens (at least two per delivery)
• Stethoscope
• Tape, ½ or ¾ inch
Miscellaneous:
• Cardiac monitor and electrodes (optional)
and/or pulse oximeter with probe.
• Oropharyngeal airways
• Syringes 1, 2, 5, 10, 20 and 50mL
• Needles- 18, 21 & 25 gauge or puncture device
for needle less system.
Medications:
• Administration of drugs is rarely indicated in resuscitation
of the NB infant. However, in rare cases the following
medications are used:
• Epinephrine 1:10,000 (0.1mg/mL) Dilute 1ml of 1:1000
solution and keep ready (0.5ml. + 4.5ml NS)
• Isotonic crystalloid (normal saline or Ringer’s lactate) for
volume expansion. (Albumin is no longer recommended). 0-
ve red cells may be used.
• Sodium bicarbonate dilute 7.5% solution 1:1 with DW to
get approximate concentration
• Naloxone hydrochloride 0.4mg/mL 1-mL ampoules; or 1.0
mg/mL 2-mL ampoules
NEONATAL RESUSCITATION
PROTOCOL
STEPS OF RESUSCITATION
Dr(col) C.G.WILSON
PROFESSOR& H.O.D(PAED)
STEPS OF RESUSCITATION
ON YOUR MARCH…….………GET SET
PREVENTION OF HEAT LOSS
PROVIDE WARMTH
AIRWAY CLEARING & CLEANING
INITIATION OF BREATHING
EVALUATION
PREVENTION OF HEAT LOSS
& PROVIDE WARMTH
DRYING – PREWARMED TOWEL
REMOVE WET TOWEL
RADIANT WARMER
EUTHERMIC ATMOSPHERE
AIRWAY MANAGEMENT
EXCESSIVE SECRETIONS &
M S A F BEFORE DRYING
POSITION - ON BACK – FLAT
HEAD SLIGHT EXTENSION
& ONESIDE
TOWEL - SHOULDER BLADE
AIRWAY CLEARING
BULB SYRINGE
De Lee MUCUS SUCKER
MECHANICAL 100mm Hg
INITIATION OF BREATHING
TACTILE STIMULATION
HARMFUL ACTIONS CONSEQUENCES
1. SLAPPING BACK BRUISING
2. SQUEEZING RIB CAGE # PNEUMO
3. FORCING THIGHS ONTO RUPUTURE OF ABDOMEN LIVER, SPLEEN
4. HOT / COLD COMPRESS HYPO / HYPER THERM
BURNS
INTER-RELATIONSHIP - RESP, HR, COLOUR
AT BIRTH - SOME -CYANOSIS
60 – 90 SEC - PINK / ACROCYANOSIS
RARELY - RESP REGULAR FREE
HR ≥ 100 MT FLOW
CENTRAL CYANO OXYGEN
INITIAL - HIGH CONCN O2 (80%)
- GRADUAL WEANING TILL
PINK AT ROOM AIR
FREE FLOW OXYGEN
OXYGEN – HEATED, HUMIDIFIED
5L / mt
NEARER TO NOSE
1/2 INCH-80% 1 INCH-60%
2INCH-40%
EVALUATION
NO BREATHING/GASP AFTER 2 TACTILES
STIMLNS
CHECK:
RESP EFFORT
HR
COLOUR
BREATHING (N)
HR > 100 / mt SUPPORTIVE CARE
PINK COLOUR
IF NOT - PROTOCOL
PROTOCOL
GASP / NO BREATHING & HR < 100
CHECK HR FOR 6 SEC X 10
CHEST COMPRESSION &
BMV – 30 SEC (100%)
HR 60 - 100 ± APNOEA
BAG & MASK WITH OXYGEN
HR < 60 ± APNOEA
30 SEC
(N) BREATHING HR
≥100 & PINK
BMV 30 SEC FREE FLOW
OXYGEN
HR < 60
HR ≥ 100 &
PINK PINK AT
ROOM AIR
DRUGS & INTUB
OROGASTRIC TUBE FOR BMV > 2 Mts
BAG & MASK VENTILATION
BAG
VALVE ASSEMBLY
SELF INFLATING / AMBU BAG
AIR INLET
OXYGEN – INLET
VALVE ASSEMBLY
PATIENT OUTLET
FACE MASK CUSHIONED RIM
0, 1, 2 SIZES
ROUND / CONICAL
CHECK EQUIPMENT
-BAG – BLOCK OUTLET & SQUEEZE
--PR RELEASE VALVE – HEAR AIR
RELEASE
CLEAN – 2% GLUTARALDEHYDE 20-40’
--WASH WITH DISTD WATER
PROCEDURE – B M V
• POSITION
• TEST – MOUTH SEAL – 2 -3 SQ. CHEST RISE
• INITIAL HIGHER PR 30 -40 CM H20
• 40 PER MT ( 30 – 60)
• CHEST COMPRESSION – 90 / mt
(ONE SQ. AFTER 3 COMPRESSIONS)
• AFTER 30 SEC, EVALUATE HR, BR, COLOUR
CONTRA
•DIA HERNA
•M S A F WITH RESP DEPRESSION (INTRA
PARTUM SUCTIONING PRIOR TO BMV)
CHEST COMPRESSION
RHYTHMIC COMPRESSION OF
STERNUM THAT:
• COMPRESS HEART AGAINST SPINE
• INCREASE INTRATHORACIC PR
• CIRCULATE BLOOD TO VITAL
ORGANS
• HEART FILLED WHEN PR RELEASED
METHOD
Two thumbs
encircling hands
Two finger
technique of chest
compression – In
the two fingers
technique the
index and the
third finger of the
hand is used
LOCATION & DEPTH
RATE OF COMPRESSION
COMPRESSION / RELEASE ACTION 90 / Mt
VENTLN – 30 / mt RATIO 3 : 1
HALF SECOND FOR EACH EVENT
• IN 2 SECONDS – 3 COMPR & 1 SQ
• IN 60 SECONDS – 90 COMPR & 30 SQ
EVALUATE AFTER 30 SEC
HR 6 SEC X 10
-CAROTID, BRACHIAL, FEMORALS FELT
PRECAUTIONS: • DO NOT REMOVE FINGER / THUMB IN BETWEEN
• FEEL THE PULSES FOR EFFECTIVENESS
• DO NOT SQUEEZE CHEST