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.
