newborn resuscitation belen amparo e. velasco, m.d

NEWBORN NEWBORN RESUSCITATIONRESUSCITATION

Belen Amparo E. Velasco, M.D.Belen Amparo E. Velasco, M.D.

TEMPERATURE (warm and dry)

ABC’s AIRWAY (position and suction) BREATHING (stimulate to cry) CIRCULATION (heart rate and

color

ASSESS AND SUPPORT

INVERTED PYRAMIDIn NB Resuscitation

Dry, Warm, Position, Suction, Stimulate

Oxygen

Establish effective ventilation

ChestCompression

Medications

PREPARATION

ADVANCED PREPARATION

IMMEDIATE PREPARATION

ADVANCED PREPARATION

OBSTETRICAL TRAY

NB RESUSCITATION TRAY

RADIANT WARMER/DROPLIGHT

NB RESUSCITATION EQUIPMENT

Bulb syringe Endotracheal tube (2.5, 3.0, 3.5) and stylets Face masks and ambubag Feeding tubes Gowns, gloves, goggles Heat source Laryngoscope handles and blades Meconium aspirator Medications and fluids Sterile UC set Suction with manometer/catheters Syringes (1, 3, 10 and 20 ml) Warmed blankets

IMMEDIATE PREPARATION

BASED ON RESUSCITATION

-ORIENTED HISTORY

VERIFICATION OF AIRWAYPATENCY AND PLACEMENT OF VASCULAR CATHETERS

RESUSCITATION-ORIENTED HISTORY

MECONIUM STAINING

PREMATURITY

TWIN PREGNANCY

NARCOTICS ADMINISTRATION TO MOTHER

FACTORS ASSOCIATED WITH INCREASED RISK FOR

NEONATAL DEPRESSION

ANTEPARTUM MATERNAL FACTORS

INTRAPARTUM MATERNAL OR FETAL FACTORS

ANTEPARTUM MATERNAL FACTORS

Maternal age > 35 or < 18 Chronic and pregnancy-induced HPN

Diabetes Hemorrhage Drug therapy (Mg, lithium,

adrenergic-blockers Substance abuse Previous abortion No prenatal care Anemia or isoimmunization

ANTEPARTUM MATERNAL FACTORS

Maternal illness (CV, thyroid, neurologic)

Multifetal gestation Small fetus for maternal dates Post-term fetus Preterm labor or PROM Immature pulmonary studies Oligohydramnios Diminished fetal activity Fetal malformation by UTZ

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INTRAPARTUM MATERNALOR FETAL FACTORS

Breech or other abnormal presentation Infection Prolonged labor Prolonged rupture of membranes Prolapsed cord Maternal sedation Operative delivery Meconium-stained AF Indices of fetal distress

UNIVERSALPRECAUTIONS

GLOVES AND OTHER APPROPRIATEPROTECTIVE BARRIERS (gowns and goggles)

SUCTION EQUIPMENT SHOULDALWAYS BE AVAILABLE

INVERTED PYRAMIDIn NB Resuscitation

Dry, Warm, Position, Suction, Stimulate

Oxygen

Establish effective ventilation

ChestCompression

Medications

INITIAL STEPS OF RESUSCITATION

(20 seconds)

PREVENTION OF HEAT LOSS

PROPER POSITIONING

SUCTIONING

TACTILE STIMULATION

TEMPERATUREREGULATION

HEAT LOSS MAY BE PREVENTED BY

REMOVING WET LINENS

DRYING THE BABY

PLACING INFANT UNDERPREHEATED LAMP/RADIANTWARMER

TEMPERATUREREGULATION

ALTERNATIVE METHODS OF WARMING:

WARM BLANKETS/TOWELS

WARM MATTRESSES

AIRWAY POSITIONING

PLACEMENT ON BACK OR SIDE WITH NECK IN NEUTRAL POSITION

SHOULDER ROLL (3/4 OR 1 inch) to EXTEND NECK SLIGHLY

AIRWAY SUCTIONING

IF MECONIUM-STAINED, TRACHEAL SUCTIONING

BULB SYRINGE SHOULD BE ADEQUATE

IF NOT MECONIUM-STAINED, SUCTION MOUTH FIRST THEN NOSTRILS

AIRWAY SUCTIONING

MAY USE MECHANICAL SUCTIONWITH 8F OR 10F SUCTION CATHETERS AT NEGATIVE PRESSURE NOT TO EXCEED -100mmHg FOR NO LONGERTHAN 3 to 5 seconds PER ATTEMPT

TACTILE STIMULATION

SLAPPING OR FLICKING THE SOLES

GENTLE RUBBING OF THE BACK

ASSESSMENT

RESPIRATORY EFFORT

HEART RATE

COLOR

INVERTED PYRAMIDIn NB Resuscitation

Dry, Warm, Position, Suction, Stimulate

Oxygen

Establish effective ventilation

ChestCompression

Medications

OXYGEN

100% OXYGEN SHOULD BE USED

PREFERABLY WARMED AND HUMIDIFIED

FREE-FLOW O2 BY O2 HOODOR BY FACE MASK ATTACHED TOAMBUBAG OR SIMPLE MASK HELD TO FACE WITH 5L/min O2 FLOW

INVERTED PYRAMIDIn NB Resuscitation

Dry, Warm, Position, Suction, Stimulate

Oxygen

Establish effective ventilation

ChestCompression

Medications

POSITIVE-PRESSUREVENTILATION

INDICATIONS

APNEA OR GASPING RESPIRATION

HEART RATE LESS THAN 100 bpm

PERSISTENT CENTRAL CYANOSIS 100% OXYGEN

POSITIVE-PRESSUREVENTILATION

• USUALLY PROVIDED WITH BAG AND MASK

• VENTILATORY RATE of 40-60/min

INVERTED PYRAMIDIn NB Resuscitation

Dry, Warm, Position, Suction, Stimulate

Oxygen

Establish effective ventilation

ChestCompression

Medications

CHEST COMPRESSION

INDICATIONS

Persistent bradycardia (60-80/min not increasing) despite 30 seconds of positive pressure ventilation

CHEST COMPRESSION

CHEST COMPRESSION AT A RATIO

with BAGGING OF 1:3 (Total of 120 events)

TWO METHODS:Thumb methodTwo-finger method

INVERTED PYRAMIDIn NB Resuscitation

Dry, Warm, Position, Suction, Stimulate

Oxygen

Establish effective ventilation

ChestCompression

Medications

MEDICATIONS

EPINEPHRINE

INDICATIONS

Heart rate of zero

Persistent bradycardia (<60/min) despite 30 seconds of positive pressure ventilation and 30 seconds of chest compression

MEDICATIONS

VOLUME EXPANDERS

INDICATIONS

Acute blood loss

Non-improvement despite adequate resuscitation

MEDICATIONS

SODIUM BICARBONATE

INDICATIONS

Documented metabolic acidosis

Cardiac arrest

MEDICATIONS

NALOXONE

INDICATIONS

Respiratory depression with maternal history of narcotic intake within four hours from the time of delivery