RESUSCITATION OF NEW BORN

New Born Resuscitation

PURPOSE

l  The main purpose of resuscitation  is to initiate respiration in a newborn,  who is asphyxiated or spontaneous breathing has not been initiated.

What risk factor are associated with the need for neonatal resuscitation?

1, ANTEPARTUM:

l  Maternal Diabetes

l  PIH

l  Bleeding in second & third trimester

l  Post term gestation

l  Maternal age less than 16 or more than 35 year.

l  Multiple pregnancies

l  Severe anemia

l  Pervious still birth

l  Maternal infection

l  Mother on drug therapy (Lithium carbonate)

l  Maternal drug abuse

2, INTRAPARTUM:

l  Abnormal presentation

l  Rupture of membrane more than 24 hrs prior to delivery.

l  Precipitate labour

l  Prolapsed cord

l  Abruptio placenta

l  Meconium stained amniotic fluid

l  Premature labour

l  Foul smell amniotic fluid

l  Prolonged labour either for first or second stage

l  Non reasoning fetal heart pattern

l  Placenta previa

PREPARATION FOR RESUSCITATION:

l  Two trained personnel capable of working together to perform all aspect of resuscitation but one of the two must be skilled in the tracheal intubation.

l  Sources of heat either radiant warmer or 200 watt bulb.

l  Adequate lighting & place to work.

Indication:

·         Asphyxia.

·         Cardiac arest

·         respiratory distress

·         Consider every birth is at risk

·         All resuscitation equipment are kept ready in labour room

·         One person from labour room should be skilled in resuscitation

·         Resuscitation room will be well lighted and warm

·         Essential articles should be good working condition

·         And should be checked by nursing personal at every duty shift.

·         Follow aseptic precaution

·         Universal precaution against HIV ALSO MIAINTAINED

EQUIPMENTS:

SUCTION EQUIPMENT:

1.      mucous aspirator,

2.       meconium aspirator

3.      mechanical suction apparatus,

4.       suction catheters,

5.      feeding tube and 20ml syringes

6.      Oxygen sources,

7.       face mask

INTUBATION EQUIPMENT:

1.      neonatal laryngoscope,

2.      with appropriate blade, (no=0 for preterm, no=1 for term)

3.      extyra bulbs and batteries, e.t tubes,

(SIZE, 2.5, 3, 3.5, 4 MM.DM0)

1.      STYLET

2.      SCISSORS

MEDICATIONS:

1.      Epinephrine

2.      Naloxone hydrochloride

3.      Normal saline

4.      Ringer lactate

5.      Naco2    

6.      Albumin 

7.      Dextrose(5%,10%) 

8.      Sterile water

9.      Ampule of injection, dopamine, slow infusion pump.

MISCELLANEOUS:

1.      Watch with sounds,

2.      Hand prewarmed linen,

3.      Towel shoulder roll

4.      Radient warmer or heat sourses,(bulb 200w)

5.      Stethscope, syringes (1,2,3,5, 10, 20, 50ml)

6.      Needles, umbilical cateters, (3.5fg, 5fg)

7.      Three way stopcocks, gloves, gauze, adhesive tape room thermometer, low radiant thermometer or tele thermometer

8.      Scalp vein set, or iv canula, neonatal airway tube, spot light

TABCs OF RESUSCITATION

T- TEMPERATURE:

1.      Provision of radiant heat sourses

2.      Drying the baby

3.      Removing wet linon

A-ESTABLISNMENT OF OPEN AIRWEY

1.      Position the infant

2.      Suction the mouth, nose and in some instance the trachea,

3.      ET tube if necessary

B-INITIATION OF BREATHING

1.      Tactile stimulation

2.      PPV, using either bag and mask or bag and ET tube

C. MAINTENANCE OF CIRCULATION

1.      Chest compression

2.      Medication

Initial step of resuscitation:

1.      Receive the baby in prewarmed linen.

2.      Dry the baby

3.      Position ther baby (1 inch away from matress, side lying neck slightly extended)

4.      Suctioning( 80mmhg)

5.      Provide tactile stimulation

6.      Using free floe oxygen

Evaluate baby:

1.      Heart rate >100b/m, skin color pink or acrocyanosis, baby need observation and monitoring only.

2.      Spontaneous respiration heart rate >100, with cyanosis at lip or tongue then flow oxygen is administered.

3.      When no spondaneous respiration PPV is started with bag and mask.

4.       spondaneous respiration and heart rate is <100 b/m PPV is started.

Bag and mask ventilation:

1.      It s,b started after tactile stimulation

2.      And the infant is still apnic and gasping and having spondaneous respiration and heart rate is <100 b/m

3.      It s, b done after tracheal suction

4.      Contraindicated in diaphragmatic hernia

5.      Baby head s,b slightly elevated to ensure open airwaymask to be place and seal to be checked by 2 -3 ventilation

6.      Rise of ches to be observed

7.      Ventilation should done at the rate of 40-60 breaths/mitfollow a squeeze ‘one’ ‘two’ squeeze sequence

8. After 15-30 sec of ventilation baby s, b again evaluated.

9. Heart rate is avove 100 and spondaneopus respiration present then provide tactile stimulation monitor heart rate, reap and color.

10. If no breating establishes continue ventilation

11. If heart rate is b/w 60-100 continue ventilation if not increasing start chest compression

Chest compression:

1.      It should be performed always with ventilation and 1005 oxygen

2.      Indicated with 15-30 sec of PPV with 100%oxygen then heart rate is 60to 80b/m and not increasinmg

Techniques:

1.      Thumb techniques

2.      Two finger techniques

Pressure is applied on lower third of the sternum (1/2 to ¾ inches)

Rate is 90 compression with 30 PPV a total of 120 events

Chest complression is 1.5 sec and ½ sec for ventilatiopn

Then carotid and femoral pulse s,b checked to assess effectiveness of chest compression.

ET TUBE INTUBATION:AND MEDICATION:

Medication:

1.       when heart rate is still 80b/m a or above  chest compression s, b discontinued, when 100b/m and have spondaneous respiration ventilation is discontinued.

2.      Umbilical vein is preferable route

3.      No intracardiac injections are recomended for neonates

4.      No direct injection into umbilical card

5.      Some medication given through ET tube

6.      Naco2 is not administetrd still the ventilation is established

7.      . No respiratory stimulant is needed

8.      8. Naco2 is diluted 1:1 with water

9.      9. Metabolic acidosis is corrected with o2 and volume expanders.

Complication of resuscitation:

l  Trauma to the heart

l  Trauma to the lungs

l  Trauma to the liver

l  Broken ribs

l  Laceration of liver and pneumothorax.