newborn resuscitation by abhishek jaguessar

8/4/2019 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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newborn resuscitation by abhishek jaguessar

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