SlideShare una empresa de Scribd logo
1 de 83
Descargar para leer sin conexión
NEONATAL RESUSCITATION
SHADAB KAMAL
What is neonatal resuscitation ?
Assessment of the fetus at birth
Identification of the babies requiring resuscitation
Initial steps of resuscitation
Pulmonary resuscitation
Vascular Resuscitation
Termination of resuscitation
Neonatal Resuscitation?
•Series of actions, used to assist
newborn babies who have difficulty
with making the physiological
‘transition’ from the intrauterine to
extrauterine life
•Most newborns are vigorous at birth.
•Approximately 10% will require some
assistance at birth to begin breathing.
•Less than 1% will require extensive
resuscitation.
RESUSCITATION EQUIPMENTS
• General: Resuscitation bed, over head
warmer (servo-controlled infrared heater),
towel, stethoscope, pulse oximeter
• Airway Mangement: Suction device with
Suction catheter ; Bulb syringe,
laryngoscope with blades (size 00 and 0);
ETT (size 2.5, 3.0, 3.5); EtCO2 detector;
LMA (size 1)
• Breathing support: Facemask; PPV device,
O2 gas, feeding tube,
• Circulation support: UVC kit, iv kit, io
needle,
• Drug and fluids:
Adrenaline(1;10000/0.1mg/ml), NS, Blood
Assessment of the newborn at birth
Cord clamping
• In the compromised newborn, the optimal
timing of cord clamping remains unknown
• The more severely compromised the
newborn the more likely it is that
resuscitation measures need to take
priority over delayed cord clamping
Initial Assessment: APGAR score
• Assesses neonatal well-being &
resuscitation.
1-min score  Acidosis and Survival
5-minute score Neurologic outcome.
• Each variable must be evaluated at 1
and 5 minutes.
Virginia Apgar
APGAR SCORE
Sign 0 1 2
Color
(Appearance)
Blue
Pale
Body pink ,
Extremities
blue
Completely
pink
Heart Rate
(Pulse)
Absent < 100/min > 100/min
Reflex Irritability
(Grimace)
Absent Grimace Cough ,
sneeze
Muscle Tone
(Activity)
None Some flexion
of extremities
Active
movement
(Respiratory Effort) Absent Slow , Good , crying
APGAR Score 8-10
• Achieved by 90% of
neonates
• Nothing is required,
except
-nasal and oral
suctioning
-drying of the skin
-maintenance of
normal body
temperature.
APGAR Score 5-7
• Suffered mild asphyxia
just before birth.
-Respond to
vigorous stimulation
-Oxygen blown
over the face.
Apgar Score 3-4
• These Neonates are moderately
depressed at birth.
• They are usually cyanotic and have poor
respiratory efforts.
• But they usually respond to BMV,
breath, and become pink.
Apgar Score 0-2
• These
neonates
severely
asphyxiated
and require
immediate
resuscitation
Which babies need resuscitation?
Newborn rapidly assessed for
● Term gestation? ●Crying or Breathing?
● Good muscle tone?
If “yes,” for all 3 questions
Baby does not need resuscitation and
should not be separated from mother.
• If “no,” for of any of the assessment
questions

• Infant should receive one or more of
the following action in sequence:
1. Initial steps in stabilization
2. Ventilation
3. Chest compressions
4. Administration of epinephrine
and/or volume expansion
(“the Golden Minute”)
• ≈60 sec for initial steps, reevaluating,
and beginning ventilation if required.
• The decision to progress beyond initial
steps is determined by simultaneous
assessment of:
▫ Respirations (apnea, gasping, or
labored or unlabored breathing)
▫ HR (whether < 100/min or > 100/min)
• HR is assessed by intermittently
auscultating the precordial pulse.
• When pulse detectable, umbilical pulse
palpation provide rapid estimate and is
more accurate than other sites.
• Pulse oximeter takes 1-2 min to apply,
• May not function during states of very
poor CO or perfusion
• Provide continuous assessment without
interruption of other resuscitation
measures
• Once PPV or supplementary O2
administration begun, assessment consist
of simultaneous evaluation of:
▫ HR, Respirations, and State of
oxygenation.
• The most sensitive indicator of a successful
response to each step  ↑ in HR.
Anticipation of Resuscitation Need
•Anticipation, adequate preparation,
accurate evaluation, and prompt
initiation of support are critical for
successful neonatal resuscitation.
• At every delivery  at least 1 person
required whose primary responsibility is
the newly born.
• This person must be capable of initiating
resuscitation, including administration of
PPV and chest compressions.
• Someone else promptly available have the
skills to perform a complete resuscitation,
including endotracheal intubation and
administration of medications.
• Majority of newborn who will need
resuscitation can be identified before birth.
• If a preterm delivery(<37weeks) is expected,
special preparations will be required.
Problems with preterm babies
1. Immature lungs- difficult to ventilate and
also more vulnerable to injury by PPV;
2. Immature blood vessels in the brain that
are prone to hemorrhage;
3. Thin skin & large BSA  Rapid heat loss;
4. Increased susceptibility to infection;
5. ↑ risk of hypovolemic shock related to
small blood volume.
NEWBORN RESUSCITATION ALGORITHM
Neonatal resuscitation
INITIAL STEPS
• To provide warmth by placing the baby
under a radiant heat source,
• Positioning the head in a “sniffing”
position to open the airway,
• Clearing the airway if necessary with a
bulb syringe or suction catheter,
• Drying the baby, and
• Stimulating respiration.
•The baby dried, placed skin-to-skin
with the mother, and covered with dry
linen to maintain temperature.
•Observation of breathing, activity, and
color should be ongoing.
Temperature Control
•VLBW (<1500 g)
preterm babies are
likely to become
hypothermic despite
the use of traditional
techniques for
decreasing heat loss.
Additional warming techniques :
• Prewarming the delivery room to 26°C,
• Covering the baby in plastic wrapping
(food or medical grade, heat-resistant
plastic)
• Placing the baby on an exothermic
mattress ,
• Placing the baby under radiant heat .
Clearing the Airway
When Amniotic Fluid Is Clear
• Deep Suctioning is avoided
▫ nasopharynx  bradycardia during
resuscitation.
▫ trachea in intubated babies receiving MV at
NICUdeterioration of pulmonary
compliance, oxygenation and ↓ CBF.
• However, suctioning in the presence of
secretions can decrease respiratory
resistance.
• Suctioning immediately following birth
should be reserved for babies who have
obvious obstruction to spontaneous
breathing or who require PPV.
When Meconium is Present
• Meconium-stained depressed infants
are at increased risk to develop
Meconium Aspiration Syndrome(MAS)
• Tracheal suctioning has not been
associated with reduction in the
incidence of MAS or mortality in these
infants.
• “Pea soup" or particulate meconium
should be removed from the lung
before breathing is established to
improve the survival of neonates with
meconium aspiration.
• Thin, watery meconium does not
require suctioning.
• Chest physical therapy and postural
drainage done every 30 min for 2 hrs
and hourly thereafter for the next 6 hrs
may help remove residual meconium
from the lung.
• All neonates born after meconium
aspiration should be observed for 24 hrs
because they can develop Persistent
Fetal Circulation syndrome.
•In the absence of randomized,
controlled trials, there is insufficient
evidence to recommend a change in
the current practice of performing
endotracheal suctioning of
nonvigorous babies with meconium-
stained amniotic fluid.
PULMONARY RESUSCITATION
Assessment of oxygen need
• PaO2 uncompromised babies generally do
not reach extrauterine values until ≈10
min following birth.
• SpO2 may normally 70% -80% for several
minutes following birth  Cyanosis.
• Optimal management of oxygen is
important because either insufficient or
excessive oxygenation can be harmful
Supplementary Oxygen
• Meta-analyses comparing room air versus
100% oxygen showed increased survival
when resuscitation was initiated with air.
• Escrig R et al found that in preterm,
initiation of resuscitation with a blend of
oxygen and air resulted in less hypoxemia
or hyperoxemia than with either air or
100% oxygen followed by titration.
•If the baby is bradycardic
(HR<60/min) after 90 seconds of
resuscitation with a lower
concentration of oxygen, oxygen
concentration should be
increased to 100% until recovery
of a normal HR.
PPV
• If newborn apneic or gasping, or if the HR
< 100/min after the initial steps  Start
PPV.
Initial Breaths and Assisted Ventilation
• Initial inflations following birth, either
spontaneous or assisted, create FRC.
• The primary measure of adequate
initial ventilation is prompt
improvement in HR.
• Chest wall movement should be
assessed if HR does not improve.
• An initial peak inflation pressure of 20 cm
H2O is effective, but 30-40 cm H2O may be
required in some term babies.
• If pressure is not being monitored, the
minimal inflation required to achieve ↑ in
HR should be used.
• Assisted ventilation @40-60 breaths/min to
promptly achieve or maintain >HR 100/min.
CPAP
• Recommended in preterm newborn
who are breathing spontaneously, but
with difficulty.
• Starting infants on CPAP, ↓ the rates of
intubation and MV, surfactant use, and
duration of ventilation, but ↑ rate of
pneumothorax.
PEEP versus no PEEP
• Although PEEP is beneficial and used
routinely during MV of neonates in NICU,
there have been no studies specifically
examining PEEP versus no PEEP when PPV
is used during establishment of an FRC
following birth.
• PEEP is likely to be beneficial and should
be used if suitable equipment is available .
PPV delivery devices
• T-piece device is preferred. PIP for term @30
cm H2O; Preterm @20-25 cm H2O; PEEP: 5-8
cm H2O; Max pressure relief valve: 50cm H2O
• Self inflating bag: Pressure release valve@
≈40 cm H2O; cannot effectively deliver CPAP,
PEEP or sustained inflation breaths
• Flow inflating (or anaesthetic) bag
Laryngeal Mask Airways
• LMA are effective for ventilating newborns
weighing > 2000 g or delivered ≥ 34 weeks
gestation.
• limited data on the use of these devices in
small preterm infants(<2000g; <34 wk).
• LMA should be considered if facemask
ventilation is unsuccessful and tracheal
intubation is unsuccessful or not feasible.
Endotracheal Tube Placement
INDICATIONS:
• Initial endotracheal suctioning of non
vigorous meconium stained newborns.
• If BMV is ineffective or prolonged.
• Newborns born without a detectable HR
• Expected need for continued or prolonged
ventilation
• For special resuscitation circumstances, such
as CDH and ELBW.
• An appropriate size ETT should be
inserted and the tip of the tube placed 1
to 2 cm below the vocal cords.
• Distance from the tip of the tube to the
gums is 7, 8, 9, or 10 cm in 1-, 2-, 3-, and
4-kg infants, respectively.
• A small gas leak should be present between
the ETT and trachea when ventilation
pressure is 15-25 cm H2O.
Appropriate size of the tube
• 2.5 mm tube for neonates weighing < 1.5 kg,
• 3.0 mm tube for 1.5-2.5 kg,
• 3.5 mm tube for > 2.5 kg.
• Prompt ↑ HR is the best indicator that the
tube is in the tracheobronchial tree and
providing effective ventilation.
• Exhaled CO2 detection is the recommended
method of confirmation of ETT placement.
• Poor or absent pulmonary blood flow may
give false-negative results (ie, no CO2
detected despite ETT in the trachea).
• Other clinical indicators of correct
endotracheal tube placement are
▫ Condensation or mist in the ETT,
▫ Chest movement,
▫ Presence of equal breath sounds
bilaterally,
▫ Improvement in skin color and SpO2.
• Because the chest is small, breath sounds
are well transmitted within the thorax.
• A difference in breath sounds between the
two sides of chest should raise suspicion of
pneumothorax, atelectasis, or a congenital
anomaly of the lung.
• Presence of loud breath sounds over the
stomach suggest Tracheoesophageal
Fistula.
• Failure to adequately ventilate the lungs
at birth may make hypoxemia worse and
lead to CNS damage or even death.
• If the PaO2 > 70-80 mm Hg or SaO2 >94%,
FiO2 (if higher FiO2 is used) should be
reduced untill SaO2 and PaO2 are normal
for age. (normal SaO2 ≈87-95%, which is
associated with a PaO2 of 55-70 mm Hg)
• Retinopathy of prematurity can occur in
premature neonates(<34 wks gestation)
with a PaO2 of ≈150 mm Hg for 2-4 hrs.
Administration of Surfactant
• Its use resulted in significant improvement in
the outcome of preterms.
• The incidences of pulmonary gas leaks, HMD
deaths, BPD, and pulmonary interstitial
emphysema are lower after surfactant use.
• Administered as liquid (Survanta@4mL/kg;
curosurf@2.5ml/kg into trachea at birth).
VASCULAR RESUSCITATION
CARDIAC MASSAGE
• indicated when HR < 60/min despite
adequate PPV with O2 for 30 seconds.
• Rescuers should ensure that assisted
ventilation is being delivered optimally
before starting chest compressions because
▫ ventilation is the most effective action and
▫ chest compressions are likely to compete
with effective ventilation,
• Compressions should be delivered on the
lower third of the sternum to a depth of
≈1/3rd of the AP diameter of the chest.
• Two techniques:
▫ compression with 2 thumbs with fingers
encircling the chest & supporting the back
▫ compression with 2 fingers with a second
hand supporting the back.
• The 2 thumb–encircling hands
technique may generate higher
peak systolic and coronary
perfusion pressure than the 2-
finger technique, So
recommended in newborns
• Compressions and ventilations should be
coordinated to avoid simultaneous delivery.
• The chest should be permitted to reexpand
fully during relaxation, but the rescuer’s
thumbs should not leave the chest.
• compressions to ventilations ratio 3:1 (i.e.
≈120 events/min to maximize ventilation at
90 compressions and 30 breaths
• Thus each event will be allotted ≈1/2sec,
with exhalation occurring during the first
compression after each ventilation.
• A 3:1 compression to ventilation ratio is used
where ventilation compromise is the
primary cause, but rescuers should consider
using higher ratios (eg, 15:2) if the arrest is
believed to be of cardiac origin.
• Respirations, HR and oxygenation should be
reassessed periodically, and coordinated
chest compressions and ventilations should
continue until the spontaneous HR ≥60/min.
• Avoid frequent interruptions of
compressions, as they will compromise
artificial maintenance of systemic perfusion
and maintenance of coronary blood flow.
• If the neonate's condition does not
improve rapidly with ventilation and
tactile stimulation, an umbilical artery
catheter should be inserted.
• Most preterm neonates weighing < 1250
gram at birth and 1-3% of term
neonates require an umbilical artery
catheter during resuscitation.
Umbilical venous catheter (UVC)
• Most rapidly accessible intravascular route
▫ to administer drugs (Adrenaline);
▫ for fluid administration to expand blood
volume,
▫ to measure blood gase, pH and arterial
BP,
• Provide continued vascular access until an
alternative route is established
RESUSCITATION DRUGS
• Bradycardia is usually the result of
inadequate lung inflation or profound
hypoxemia, and establishing adequate
ventilation is the most important step.
• if the HR remains < 60/min despite one
minute of adequate ventilation and chest
compressions with100% O2,adrenaline or
volume expansion or both are indicated
• IV is the preferred route: UVC is
preferable to intraosseous
• Recommended IV dose is 0.01-0.03
mg/kg/dose; rapid bolus followed
by 1ml of 0.9% NS flush
•Intratracheal dose is higher(0.05 to
0.1 mg/kg); 1:10,000 (0.1 mg/mL);
may be considered while IV access
is being obtained; Follow with PPV –
Flush not recommended
•Can be repeated every 5 minutes, if
HR remains < 60/min.
Volume Expansion
Detection of Hypovolemia
• measuring the arterial BP and
• by physical examination (i.e. pale skin color,
have poor capillary refill time, poor skin
perfusion, extremities are cold, and pulses
(radial and posterior tibial) are weak or
absent, and temperature).
• CVP measurements are helpful in detecting
hypovolemia and in determining the
adequacy of fluid replacement.
• Normal CVP in neonates is 2-8 cm H2O.
• If CVP < 2 cm H2O, hypovolemia suspected.
Treatment of Hypovolemia
• The key is intravascular volume expansion.
• Best be done with blood and crystalloids
• If hypovolemia is suspected at birth, Rh-
negative type O PRBCs should be available in
delivery room before neonate is born.
• Crystalloid and blood should be titrated in 10
mL/kg and given slowly over 10 minutes.
• At times, >50% of the blood volume (85
mL/kg in term; and 100 mL/kg in preterm)
must be replaced, especially when the
placenta is transected or abrupted.
• In most cases, <10-20 mL/kg of volume
restores mean arterial pressure to normal.
• Care should be taken to avoid giving volume
expanders rapidly, because rapid infusions of
large volumes have been associated with
hypertension and IVH.
• Hypertension may disrupt the intracerebral
vessels and cause intracranial hemorrhage if
cerebrovascular autoregulation is absent.
Postresuscitation Care
• Babies who require resuscitation are at risk
for deterioration after their vital signs have
returned to normal.
• Once adequate ventilation and circulation
have been established, the infant should be
maintained in, or transferred to an
environment where close monitoring and
anticipatory care can be provided.
Monitoring required may include:
• Oxygen saturation(SpO2)
• Heart rate and ECG
• Respiratory rate and pattern
• Blood glucose measurement
• Blood gas analysis
• Fluid balance and nutrition
• Blood pressure
• Temperature
• Neurological
Role of Glucose
• Newborns with lower blood glucose levels
are at ↑ risk for brain injury so maintain
BGL >2.5 mmol/L.
• If the blood glucose concentration is low,
bolus of glucose (0.5 to 1.0 mL/kg of 10%
dextrose) and constant infusion of 5-7
mg/kg/min intravenously is given .
Induced Therapeutic Hypothermia
• Infants born ≥36 weeks gestation with
evolving moderate to severe hypoxic-
ischemic encephalopathy should be offered
therapeutic hypothermia (33.5-34.5⁰C).
• The treatment according to the studied
protocols include commencement within 6
hrs following birth, continuation for 72 hrs,
and slow rewarming over at least 4 hours.
Guidelines for Withholding and
Discontinuing Resuscitation
• It is based on the physician's experience and
desires of the parents.
• In making the decision, the physician must
consider the probability of neurologic
damage and chances of a productive, useful
life are poor, consideration should be given
to discontinuing all resuscitative efforts.
Withholding Resuscitation
• It may be considered reasonable, when there
have been conditions with poor outcome
(i.e. gestation, birth weight, or congenital
anomalies are associated with almost certain
early death or unacceptably high morbidity
is likely among the rare survivors) and
opportunity for parental agreement, (eg <23
wk gestation; BW<400g; trisomy 13)
• conditions with ↑rate of survival, acceptable
morbidity (with ≥ 25 wks gestation and with
most congenital malformations, resuscitation
is always indicated.
• Conditions with borderline survival, high
morbidity rate and uncertain prognosis,
parental desires concerning initiation of
resuscitation should be supported.
Discontinuing Resuscitative Efforts
• In a newly born baby with no detectable
HR, resuscitation are discontinued if the
HR remains undetectable for 10 min.
• resuscitation efforts beyond 10 min with
no HR should be considered if presumed
etiology of the arrest, gestation of the
baby, and the parental desire.
LETS GIVE OUR NEWBORN A GOODSTART!
Thanks……..
Risk factors for neonatal resuscitation
Maternal
• PROM (> 18 hours)
• Bleeding in 2nd or 3rd
trimester
• PIH
• Substance abuse
• Drug
• Diabetes mellitus
• Chronic illness
• Maternal pyrexia
• Maternal infection
• Chorioamnionitis
• Heavy sedation
• Previous fetal or
neonatal death
Fetal
•Multiple gestation
•gestation (< 35 wks; >41
wks)
•Large for dates
•IUGR
•Alloimmune haemolytic
disease
•Polyhydramnios and
oligohydramnios
•Reduced fetal movement
before onset of labour
•Congenital abnormalities
which may effect breathing,
cardiovascular function or
other aspects of perinatal
transition
•Intrauterine infection
•Hydrops fetalis
Intrapartum
•Non reassuring FHR
patterns on CTG
•Abnormal presentation
•Prolapsed cord
•Prolonged labour
•APH(e.g. abruption,
placenta praevia, vasa
praevia)
•Meconium in the amniotic
fluid
•Narcotic administration to
mother within 4 hours of
birth
•Forceps birth
•Vacuum-assisted
(ventouse) birth
•Maternal GA

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Pph
PphPph
Pph
 
Breastfeeding
BreastfeedingBreastfeeding
Breastfeeding
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitation
 
KANGAROO MOTHER CARE -DETAILED
KANGAROO MOTHER CARE -DETAILEDKANGAROO MOTHER CARE -DETAILED
KANGAROO MOTHER CARE -DETAILED
 
Respiratory distress syndrome
Respiratory distress syndromeRespiratory distress syndrome
Respiratory distress syndrome
 
Preterm
PretermPreterm
Preterm
 
Breast feeding
Breast feedingBreast feeding
Breast feeding
 
care of child on ventilator
care of child on ventilatorcare of child on ventilator
care of child on ventilator
 
Eclampsia ppt
Eclampsia pptEclampsia ppt
Eclampsia ppt
 
Asphyxia neonatorum
Asphyxia neonatorumAsphyxia neonatorum
Asphyxia neonatorum
 
KANGAROO MOTHER CARE
KANGAROO MOTHER CAREKANGAROO MOTHER CARE
KANGAROO MOTHER CARE
 
Placenta previa
Placenta previaPlacenta previa
Placenta previa
 
Induction of labor
Induction of laborInduction of labor
Induction of labor
 
Meconium aspiration syndrome_
Meconium aspiration syndrome_Meconium aspiration syndrome_
Meconium aspiration syndrome_
 
pre eclampsia
pre eclampsiapre eclampsia
pre eclampsia
 
Care of preterm babies
Care of preterm babiesCare of preterm babies
Care of preterm babies
 
Neonatal jaundice - 2017
Neonatal jaundice   - 2017Neonatal jaundice   - 2017
Neonatal jaundice - 2017
 
Meconium aspiration syndrome
Meconium aspiration syndromeMeconium aspiration syndrome
Meconium aspiration syndrome
 
Hyperemesis gravidarum
Hyperemesis gravidarumHyperemesis gravidarum
Hyperemesis gravidarum
 
Baby Friendly Hospital Initiatives (BFHI)
Baby Friendly Hospital Initiatives (BFHI)Baby Friendly Hospital Initiatives (BFHI)
Baby Friendly Hospital Initiatives (BFHI)
 

Destacado (10)

Neonatal resuscitation programme, NRP
Neonatal  resuscitation programme, NRPNeonatal  resuscitation programme, NRP
Neonatal resuscitation programme, NRP
 
Neonatal Resuscitation
Neonatal ResuscitationNeonatal Resuscitation
Neonatal Resuscitation
 
Newborn assessment
Newborn assessmentNewborn assessment
Newborn assessment
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitation
 
Neonatal resuscitation 2015
Neonatal resuscitation 2015Neonatal resuscitation 2015
Neonatal resuscitation 2015
 
Newborn Assessment by Hadi Hospital NICU.
Newborn Assessment by Hadi Hospital NICU.Newborn Assessment by Hadi Hospital NICU.
Newborn Assessment by Hadi Hospital NICU.
 
Approach to neonatal jaundice
Approach to neonatal jaundiceApproach to neonatal jaundice
Approach to neonatal jaundice
 
Assessment of the new born
Assessment of the new bornAssessment of the new born
Assessment of the new born
 
Newborn assessment
Newborn assessmentNewborn assessment
Newborn assessment
 
Neonatal Jaundice
Neonatal JaundiceNeonatal Jaundice
Neonatal Jaundice
 

Similar a Neonatal resuscitation

neonatL resuscitation
neonatL resuscitation neonatL resuscitation
neonatL resuscitation KhodifadVijay
 
Newborn Resuscitation
Newborn ResuscitationNewborn Resuscitation
Newborn ResuscitationCSN Vittal
 
Newborn resuscitation program
Newborn resuscitation programNewborn resuscitation program
Newborn resuscitation programBryan Atas
 
NEONATAL RESUSCITATION PROGRAM/NALS - LATEST GUIDELINES 7TH EDITION
NEONATAL RESUSCITATION PROGRAM/NALS  - LATEST GUIDELINES 7TH EDITIONNEONATAL RESUSCITATION PROGRAM/NALS  - LATEST GUIDELINES 7TH EDITION
NEONATAL RESUSCITATION PROGRAM/NALS - LATEST GUIDELINES 7TH EDITIONapoorvaerukulla
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitationKIMS
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitationMohd Maghyreh
 
NEWBORN RESUSCITATION.pptx
NEWBORN RESUSCITATION.pptxNEWBORN RESUSCITATION.pptx
NEWBORN RESUSCITATION.pptxMubarackBakar
 
Neonatal Resuscitation Program (NRP) 2010
Neonatal Resuscitation Program (NRP) 2010Neonatal Resuscitation Program (NRP) 2010
Neonatal Resuscitation Program (NRP) 2010deiaaldeen khudhair
 
Unit IV new born.pptx in obstetrics and gynecology
Unit IV new born.pptx in obstetrics and gynecologyUnit IV new born.pptx in obstetrics and gynecology
Unit IV new born.pptx in obstetrics and gynecologyDelphyVarghese
 
Neonatal Resuscitation Program NRP
Neonatal Resuscitation Program NRPNeonatal Resuscitation Program NRP
Neonatal Resuscitation Program NRPPallav Singhal
 
Care in labour room &amp; resuscitation
Care in labour room &amp; resuscitationCare in labour room &amp; resuscitation
Care in labour room &amp; resuscitationAshikMajumder1
 
Code pink
Code pinkCode pink
Code pinktbf413
 
Found_39927be00-d1000.ppt
Found_39927be00-d1000.pptFound_39927be00-d1000.ppt
Found_39927be00-d1000.pptAmirAhmedGeza
 
CARE FOR THE NEWBORN BABY.pptx
CARE FOR THE NEWBORN BABY.pptxCARE FOR THE NEWBORN BABY.pptx
CARE FOR THE NEWBORN BABY.pptxBIRHANETESFAY1
 
CARE FOR THE NEWBORN BABY.pptx
CARE FOR THE NEWBORN BABY.pptxCARE FOR THE NEWBORN BABY.pptx
CARE FOR THE NEWBORN BABY.pptxBIRHANETESFAY1
 

Similar a Neonatal resuscitation (20)

neonatL resuscitation
neonatL resuscitation neonatL resuscitation
neonatL resuscitation
 
Newborn Resuscitation
Newborn ResuscitationNewborn Resuscitation
Newborn Resuscitation
 
Newborn resuscitation program
Newborn resuscitation programNewborn resuscitation program
Newborn resuscitation program
 
NEONATAL RESUSCITATION PROGRAM/NALS - LATEST GUIDELINES 7TH EDITION
NEONATAL RESUSCITATION PROGRAM/NALS  - LATEST GUIDELINES 7TH EDITIONNEONATAL RESUSCITATION PROGRAM/NALS  - LATEST GUIDELINES 7TH EDITION
NEONATAL RESUSCITATION PROGRAM/NALS - LATEST GUIDELINES 7TH EDITION
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitation
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitation
 
NEWBORN RESUSCITATION.pptx
NEWBORN RESUSCITATION.pptxNEWBORN RESUSCITATION.pptx
NEWBORN RESUSCITATION.pptx
 
nrp.pptx
nrp.pptxnrp.pptx
nrp.pptx
 
NNR.ppt
NNR.pptNNR.ppt
NNR.ppt
 
NNR health.ppt
NNR health.pptNNR health.ppt
NNR health.ppt
 
Neonatal Resuscitation Program (NRP) 2010
Neonatal Resuscitation Program (NRP) 2010Neonatal Resuscitation Program (NRP) 2010
Neonatal Resuscitation Program (NRP) 2010
 
Unit IV new born.pptx in obstetrics and gynecology
Unit IV new born.pptx in obstetrics and gynecologyUnit IV new born.pptx in obstetrics and gynecology
Unit IV new born.pptx in obstetrics and gynecology
 
Nrp 2010
Nrp 2010Nrp 2010
Nrp 2010
 
Neonatal Resuscitation Program NRP
Neonatal Resuscitation Program NRPNeonatal Resuscitation Program NRP
Neonatal Resuscitation Program NRP
 
Care in labour room &amp; resuscitation
Care in labour room &amp; resuscitationCare in labour room &amp; resuscitation
Care in labour room &amp; resuscitation
 
Code pink
Code pinkCode pink
Code pink
 
Found_39927be00-d1000.ppt
Found_39927be00-d1000.pptFound_39927be00-d1000.ppt
Found_39927be00-d1000.ppt
 
Enc lecture2
Enc lecture2Enc lecture2
Enc lecture2
 
CARE FOR THE NEWBORN BABY.pptx
CARE FOR THE NEWBORN BABY.pptxCARE FOR THE NEWBORN BABY.pptx
CARE FOR THE NEWBORN BABY.pptx
 
CARE FOR THE NEWBORN BABY.pptx
CARE FOR THE NEWBORN BABY.pptxCARE FOR THE NEWBORN BABY.pptx
CARE FOR THE NEWBORN BABY.pptx
 

Más de DR SHADAB KAMAL

ACID BASE DISORDER AND ARTERIAL BLOOD GAS
ACID BASE DISORDER AND ARTERIAL BLOOD GASACID BASE DISORDER AND ARTERIAL BLOOD GAS
ACID BASE DISORDER AND ARTERIAL BLOOD GASDR SHADAB KAMAL
 
Perioperative cardiac medications in high risk patients
Perioperative cardiac medications in high risk patientsPerioperative cardiac medications in high risk patients
Perioperative cardiac medications in high risk patientsDR SHADAB KAMAL
 
approach to a case of difficult airway with special referance to Trauma
approach to a case of difficult airway with special referance to Traumaapproach to a case of difficult airway with special referance to Trauma
approach to a case of difficult airway with special referance to TraumaDR SHADAB KAMAL
 
Facemask , oral and nasal airways
Facemask , oral and nasal airwaysFacemask , oral and nasal airways
Facemask , oral and nasal airwaysDR SHADAB KAMAL
 
Acute pain management & preemptive analgesia (3)
Acute pain management & preemptive analgesia (3)Acute pain management & preemptive analgesia (3)
Acute pain management & preemptive analgesia (3)DR SHADAB KAMAL
 
Anesthesia in ophthalmic surgery and complications
Anesthesia in ophthalmic surgery and complicationsAnesthesia in ophthalmic surgery and complications
Anesthesia in ophthalmic surgery and complicationsDR SHADAB KAMAL
 
Massive transfusion protocol
Massive transfusion protocolMassive transfusion protocol
Massive transfusion protocolDR SHADAB KAMAL
 
Determinants of ventricular performance
Determinants  of  ventricular  performanceDeterminants  of  ventricular  performance
Determinants of ventricular performanceDR SHADAB KAMAL
 

Más de DR SHADAB KAMAL (13)

ACID BASE DISORDER AND ARTERIAL BLOOD GAS
ACID BASE DISORDER AND ARTERIAL BLOOD GASACID BASE DISORDER AND ARTERIAL BLOOD GAS
ACID BASE DISORDER AND ARTERIAL BLOOD GAS
 
shadab kamal
shadab kamalshadab kamal
shadab kamal
 
Perioperative cardiac medications in high risk patients
Perioperative cardiac medications in high risk patientsPerioperative cardiac medications in high risk patients
Perioperative cardiac medications in high risk patients
 
approach to a case of difficult airway with special referance to Trauma
approach to a case of difficult airway with special referance to Traumaapproach to a case of difficult airway with special referance to Trauma
approach to a case of difficult airway with special referance to Trauma
 
Facemask , oral and nasal airways
Facemask , oral and nasal airwaysFacemask , oral and nasal airways
Facemask , oral and nasal airways
 
One lung ventilation
One lung ventilationOne lung ventilation
One lung ventilation
 
Acute pain management & preemptive analgesia (3)
Acute pain management & preemptive analgesia (3)Acute pain management & preemptive analgesia (3)
Acute pain management & preemptive analgesia (3)
 
Anesthesia in ophthalmic surgery and complications
Anesthesia in ophthalmic surgery and complicationsAnesthesia in ophthalmic surgery and complications
Anesthesia in ophthalmic surgery and complications
 
Massive transfusion protocol
Massive transfusion protocolMassive transfusion protocol
Massive transfusion protocol
 
Intracatheters
IntracathetersIntracatheters
Intracatheters
 
Determinants of ventricular performance
Determinants  of  ventricular  performanceDeterminants  of  ventricular  performance
Determinants of ventricular performance
 
Consumer protection act
Consumer protection actConsumer protection act
Consumer protection act
 
Artificial blood
Artificial bloodArtificial blood
Artificial blood
 

Último

FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11crzljavier
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementIris Thiele Isip-Tan
 
Artificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, BenefitsArtificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, BenefitsIris Thiele Isip-Tan
 
Presentation on COUNSELING. 1ST YEAR GNM ,COMMUNITY HEALTH NURSING
Presentation on  COUNSELING. 1ST YEAR GNM ,COMMUNITY HEALTH NURSINGPresentation on  COUNSELING. 1ST YEAR GNM ,COMMUNITY HEALTH NURSING
Presentation on COUNSELING. 1ST YEAR GNM ,COMMUNITY HEALTH NURSINGKREDASONBANGALORE
 
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....sharyurangari111
 
Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)bishwabandhuniraula
 
ARTHRITIS.pptx Prepared by monika gopal Tutor
ARTHRITIS.pptx Prepared  by monika gopal TutorARTHRITIS.pptx Prepared  by monika gopal Tutor
ARTHRITIS.pptx Prepared by monika gopal TutorNehaKewat
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadAlex Clapson
 
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
LARYNGEAL CANCER.pptx  Prepared by Neha KewatLARYNGEAL CANCER.pptx  Prepared by Neha Kewat
LARYNGEAL CANCER.pptx Prepared by Neha KewatNehaKewat
 
Introduction to Evaluation and Skin Benefits
Introduction to Evaluation and Skin BenefitsIntroduction to Evaluation and Skin Benefits
Introduction to Evaluation and Skin Benefitssahilgabhane29
 
Eating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports PsychologyEating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports Psychologyshantisphysio
 
21 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 202421 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 2024Traumasoft LLC
 
Medical Malpractice & Medical Negligence (1).pptx
Medical Malpractice & Medical Negligence (1).pptxMedical Malpractice & Medical Negligence (1).pptx
Medical Malpractice & Medical Negligence (1).pptxanukshadias2
 
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete HealthLiving Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete HealthLyons Health
 
Blood(The Applied Physiology) for Nurses.pptx
Blood(The Applied Physiology) for Nurses.pptxBlood(The Applied Physiology) for Nurses.pptx
Blood(The Applied Physiology) for Nurses.pptxNagamani Manjunath
 
Health literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxHealth literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxPamela McKinney
 
EYE CANCER.pptx prepared by Neha kewat digital learning
EYE CANCER.pptx prepared by  Neha kewat digital learningEYE CANCER.pptx prepared by  Neha kewat digital learning
EYE CANCER.pptx prepared by Neha kewat digital learningNehaKewat
 

Último (20)

FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes Management
 
Artificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, BenefitsArtificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, Benefits
 
Annual Training
Annual TrainingAnnual Training
Annual Training
 
Presentation on COUNSELING. 1ST YEAR GNM ,COMMUNITY HEALTH NURSING
Presentation on  COUNSELING. 1ST YEAR GNM ,COMMUNITY HEALTH NURSINGPresentation on  COUNSELING. 1ST YEAR GNM ,COMMUNITY HEALTH NURSING
Presentation on COUNSELING. 1ST YEAR GNM ,COMMUNITY HEALTH NURSING
 
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
 
Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)
 
ARTHRITIS.pptx Prepared by monika gopal Tutor
ARTHRITIS.pptx Prepared  by monika gopal TutorARTHRITIS.pptx Prepared  by monika gopal Tutor
ARTHRITIS.pptx Prepared by monika gopal Tutor
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion instead
 
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
LARYNGEAL CANCER.pptx  Prepared by Neha KewatLARYNGEAL CANCER.pptx  Prepared by Neha Kewat
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
 
SCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATIONSCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATION
 
Introduction to Evaluation and Skin Benefits
Introduction to Evaluation and Skin BenefitsIntroduction to Evaluation and Skin Benefits
Introduction to Evaluation and Skin Benefits
 
Eating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports PsychologyEating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports Psychology
 
21 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 202421 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 2024
 
The Power of Active listening - Tool in effective communication.pdf
The Power of Active listening - Tool in effective communication.pdfThe Power of Active listening - Tool in effective communication.pdf
The Power of Active listening - Tool in effective communication.pdf
 
Medical Malpractice & Medical Negligence (1).pptx
Medical Malpractice & Medical Negligence (1).pptxMedical Malpractice & Medical Negligence (1).pptx
Medical Malpractice & Medical Negligence (1).pptx
 
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete HealthLiving Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
 
Blood(The Applied Physiology) for Nurses.pptx
Blood(The Applied Physiology) for Nurses.pptxBlood(The Applied Physiology) for Nurses.pptx
Blood(The Applied Physiology) for Nurses.pptx
 
Health literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxHealth literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptx
 
EYE CANCER.pptx prepared by Neha kewat digital learning
EYE CANCER.pptx prepared by  Neha kewat digital learningEYE CANCER.pptx prepared by  Neha kewat digital learning
EYE CANCER.pptx prepared by Neha kewat digital learning
 

Neonatal resuscitation

  • 2. What is neonatal resuscitation ? Assessment of the fetus at birth Identification of the babies requiring resuscitation Initial steps of resuscitation Pulmonary resuscitation Vascular Resuscitation Termination of resuscitation
  • 3. Neonatal Resuscitation? •Series of actions, used to assist newborn babies who have difficulty with making the physiological ‘transition’ from the intrauterine to extrauterine life
  • 4. •Most newborns are vigorous at birth. •Approximately 10% will require some assistance at birth to begin breathing. •Less than 1% will require extensive resuscitation.
  • 5. RESUSCITATION EQUIPMENTS • General: Resuscitation bed, over head warmer (servo-controlled infrared heater), towel, stethoscope, pulse oximeter • Airway Mangement: Suction device with Suction catheter ; Bulb syringe, laryngoscope with blades (size 00 and 0); ETT (size 2.5, 3.0, 3.5); EtCO2 detector; LMA (size 1)
  • 6. • Breathing support: Facemask; PPV device, O2 gas, feeding tube, • Circulation support: UVC kit, iv kit, io needle, • Drug and fluids: Adrenaline(1;10000/0.1mg/ml), NS, Blood
  • 7. Assessment of the newborn at birth Cord clamping • In the compromised newborn, the optimal timing of cord clamping remains unknown • The more severely compromised the newborn the more likely it is that resuscitation measures need to take priority over delayed cord clamping
  • 8. Initial Assessment: APGAR score • Assesses neonatal well-being & resuscitation. 1-min score  Acidosis and Survival 5-minute score Neurologic outcome. • Each variable must be evaluated at 1 and 5 minutes.
  • 10. APGAR SCORE Sign 0 1 2 Color (Appearance) Blue Pale Body pink , Extremities blue Completely pink Heart Rate (Pulse) Absent < 100/min > 100/min Reflex Irritability (Grimace) Absent Grimace Cough , sneeze Muscle Tone (Activity) None Some flexion of extremities Active movement (Respiratory Effort) Absent Slow , Good , crying
  • 11. APGAR Score 8-10 • Achieved by 90% of neonates • Nothing is required, except -nasal and oral suctioning -drying of the skin -maintenance of normal body temperature.
  • 12. APGAR Score 5-7 • Suffered mild asphyxia just before birth. -Respond to vigorous stimulation -Oxygen blown over the face.
  • 13. Apgar Score 3-4 • These Neonates are moderately depressed at birth. • They are usually cyanotic and have poor respiratory efforts. • But they usually respond to BMV, breath, and become pink.
  • 14. Apgar Score 0-2 • These neonates severely asphyxiated and require immediate resuscitation
  • 15. Which babies need resuscitation? Newborn rapidly assessed for ● Term gestation? ●Crying or Breathing? ● Good muscle tone? If “yes,” for all 3 questions Baby does not need resuscitation and should not be separated from mother.
  • 16. • If “no,” for of any of the assessment questions  • Infant should receive one or more of the following action in sequence: 1. Initial steps in stabilization 2. Ventilation 3. Chest compressions 4. Administration of epinephrine and/or volume expansion
  • 17. (“the Golden Minute”) • ≈60 sec for initial steps, reevaluating, and beginning ventilation if required. • The decision to progress beyond initial steps is determined by simultaneous assessment of: ▫ Respirations (apnea, gasping, or labored or unlabored breathing) ▫ HR (whether < 100/min or > 100/min)
  • 18. • HR is assessed by intermittently auscultating the precordial pulse. • When pulse detectable, umbilical pulse palpation provide rapid estimate and is more accurate than other sites.
  • 19. • Pulse oximeter takes 1-2 min to apply, • May not function during states of very poor CO or perfusion • Provide continuous assessment without interruption of other resuscitation measures
  • 20. • Once PPV or supplementary O2 administration begun, assessment consist of simultaneous evaluation of: ▫ HR, Respirations, and State of oxygenation. • The most sensitive indicator of a successful response to each step  ↑ in HR.
  • 21. Anticipation of Resuscitation Need •Anticipation, adequate preparation, accurate evaluation, and prompt initiation of support are critical for successful neonatal resuscitation.
  • 22. • At every delivery  at least 1 person required whose primary responsibility is the newly born. • This person must be capable of initiating resuscitation, including administration of PPV and chest compressions.
  • 23. • Someone else promptly available have the skills to perform a complete resuscitation, including endotracheal intubation and administration of medications. • Majority of newborn who will need resuscitation can be identified before birth. • If a preterm delivery(<37weeks) is expected, special preparations will be required.
  • 24. Problems with preterm babies 1. Immature lungs- difficult to ventilate and also more vulnerable to injury by PPV; 2. Immature blood vessels in the brain that are prone to hemorrhage; 3. Thin skin & large BSA  Rapid heat loss; 4. Increased susceptibility to infection; 5. ↑ risk of hypovolemic shock related to small blood volume.
  • 27. INITIAL STEPS • To provide warmth by placing the baby under a radiant heat source, • Positioning the head in a “sniffing” position to open the airway, • Clearing the airway if necessary with a bulb syringe or suction catheter, • Drying the baby, and • Stimulating respiration.
  • 28. •The baby dried, placed skin-to-skin with the mother, and covered with dry linen to maintain temperature. •Observation of breathing, activity, and color should be ongoing.
  • 29. Temperature Control •VLBW (<1500 g) preterm babies are likely to become hypothermic despite the use of traditional techniques for decreasing heat loss.
  • 30. Additional warming techniques : • Prewarming the delivery room to 26°C, • Covering the baby in plastic wrapping (food or medical grade, heat-resistant plastic) • Placing the baby on an exothermic mattress , • Placing the baby under radiant heat .
  • 31. Clearing the Airway When Amniotic Fluid Is Clear • Deep Suctioning is avoided ▫ nasopharynx  bradycardia during resuscitation. ▫ trachea in intubated babies receiving MV at NICUdeterioration of pulmonary compliance, oxygenation and ↓ CBF.
  • 32. • However, suctioning in the presence of secretions can decrease respiratory resistance. • Suctioning immediately following birth should be reserved for babies who have obvious obstruction to spontaneous breathing or who require PPV.
  • 33. When Meconium is Present • Meconium-stained depressed infants are at increased risk to develop Meconium Aspiration Syndrome(MAS) • Tracheal suctioning has not been associated with reduction in the incidence of MAS or mortality in these infants.
  • 34. • “Pea soup" or particulate meconium should be removed from the lung before breathing is established to improve the survival of neonates with meconium aspiration. • Thin, watery meconium does not require suctioning.
  • 35. • Chest physical therapy and postural drainage done every 30 min for 2 hrs and hourly thereafter for the next 6 hrs may help remove residual meconium from the lung. • All neonates born after meconium aspiration should be observed for 24 hrs because they can develop Persistent Fetal Circulation syndrome.
  • 36. •In the absence of randomized, controlled trials, there is insufficient evidence to recommend a change in the current practice of performing endotracheal suctioning of nonvigorous babies with meconium- stained amniotic fluid.
  • 38. Assessment of oxygen need • PaO2 uncompromised babies generally do not reach extrauterine values until ≈10 min following birth. • SpO2 may normally 70% -80% for several minutes following birth  Cyanosis. • Optimal management of oxygen is important because either insufficient or excessive oxygenation can be harmful
  • 39. Supplementary Oxygen • Meta-analyses comparing room air versus 100% oxygen showed increased survival when resuscitation was initiated with air. • Escrig R et al found that in preterm, initiation of resuscitation with a blend of oxygen and air resulted in less hypoxemia or hyperoxemia than with either air or 100% oxygen followed by titration.
  • 40. •If the baby is bradycardic (HR<60/min) after 90 seconds of resuscitation with a lower concentration of oxygen, oxygen concentration should be increased to 100% until recovery of a normal HR.
  • 41. PPV • If newborn apneic or gasping, or if the HR < 100/min after the initial steps  Start PPV. Initial Breaths and Assisted Ventilation • Initial inflations following birth, either spontaneous or assisted, create FRC.
  • 42. • The primary measure of adequate initial ventilation is prompt improvement in HR. • Chest wall movement should be assessed if HR does not improve.
  • 43. • An initial peak inflation pressure of 20 cm H2O is effective, but 30-40 cm H2O may be required in some term babies. • If pressure is not being monitored, the minimal inflation required to achieve ↑ in HR should be used. • Assisted ventilation @40-60 breaths/min to promptly achieve or maintain >HR 100/min.
  • 44. CPAP • Recommended in preterm newborn who are breathing spontaneously, but with difficulty. • Starting infants on CPAP, ↓ the rates of intubation and MV, surfactant use, and duration of ventilation, but ↑ rate of pneumothorax.
  • 45. PEEP versus no PEEP • Although PEEP is beneficial and used routinely during MV of neonates in NICU, there have been no studies specifically examining PEEP versus no PEEP when PPV is used during establishment of an FRC following birth. • PEEP is likely to be beneficial and should be used if suitable equipment is available .
  • 46. PPV delivery devices • T-piece device is preferred. PIP for term @30 cm H2O; Preterm @20-25 cm H2O; PEEP: 5-8 cm H2O; Max pressure relief valve: 50cm H2O • Self inflating bag: Pressure release valve@ ≈40 cm H2O; cannot effectively deliver CPAP, PEEP or sustained inflation breaths • Flow inflating (or anaesthetic) bag
  • 47. Laryngeal Mask Airways • LMA are effective for ventilating newborns weighing > 2000 g or delivered ≥ 34 weeks gestation. • limited data on the use of these devices in small preterm infants(<2000g; <34 wk). • LMA should be considered if facemask ventilation is unsuccessful and tracheal intubation is unsuccessful or not feasible.
  • 48. Endotracheal Tube Placement INDICATIONS: • Initial endotracheal suctioning of non vigorous meconium stained newborns. • If BMV is ineffective or prolonged. • Newborns born without a detectable HR • Expected need for continued or prolonged ventilation • For special resuscitation circumstances, such as CDH and ELBW.
  • 49. • An appropriate size ETT should be inserted and the tip of the tube placed 1 to 2 cm below the vocal cords. • Distance from the tip of the tube to the gums is 7, 8, 9, or 10 cm in 1-, 2-, 3-, and 4-kg infants, respectively.
  • 50. • A small gas leak should be present between the ETT and trachea when ventilation pressure is 15-25 cm H2O. Appropriate size of the tube • 2.5 mm tube for neonates weighing < 1.5 kg, • 3.0 mm tube for 1.5-2.5 kg, • 3.5 mm tube for > 2.5 kg.
  • 51. • Prompt ↑ HR is the best indicator that the tube is in the tracheobronchial tree and providing effective ventilation. • Exhaled CO2 detection is the recommended method of confirmation of ETT placement. • Poor or absent pulmonary blood flow may give false-negative results (ie, no CO2 detected despite ETT in the trachea).
  • 52. • Other clinical indicators of correct endotracheal tube placement are ▫ Condensation or mist in the ETT, ▫ Chest movement, ▫ Presence of equal breath sounds bilaterally, ▫ Improvement in skin color and SpO2.
  • 53. • Because the chest is small, breath sounds are well transmitted within the thorax. • A difference in breath sounds between the two sides of chest should raise suspicion of pneumothorax, atelectasis, or a congenital anomaly of the lung.
  • 54. • Presence of loud breath sounds over the stomach suggest Tracheoesophageal Fistula. • Failure to adequately ventilate the lungs at birth may make hypoxemia worse and lead to CNS damage or even death.
  • 55. • If the PaO2 > 70-80 mm Hg or SaO2 >94%, FiO2 (if higher FiO2 is used) should be reduced untill SaO2 and PaO2 are normal for age. (normal SaO2 ≈87-95%, which is associated with a PaO2 of 55-70 mm Hg) • Retinopathy of prematurity can occur in premature neonates(<34 wks gestation) with a PaO2 of ≈150 mm Hg for 2-4 hrs.
  • 56. Administration of Surfactant • Its use resulted in significant improvement in the outcome of preterms. • The incidences of pulmonary gas leaks, HMD deaths, BPD, and pulmonary interstitial emphysema are lower after surfactant use. • Administered as liquid (Survanta@4mL/kg; curosurf@2.5ml/kg into trachea at birth).
  • 58. CARDIAC MASSAGE • indicated when HR < 60/min despite adequate PPV with O2 for 30 seconds. • Rescuers should ensure that assisted ventilation is being delivered optimally before starting chest compressions because ▫ ventilation is the most effective action and ▫ chest compressions are likely to compete with effective ventilation,
  • 59. • Compressions should be delivered on the lower third of the sternum to a depth of ≈1/3rd of the AP diameter of the chest. • Two techniques: ▫ compression with 2 thumbs with fingers encircling the chest & supporting the back ▫ compression with 2 fingers with a second hand supporting the back.
  • 60. • The 2 thumb–encircling hands technique may generate higher peak systolic and coronary perfusion pressure than the 2- finger technique, So recommended in newborns
  • 61. • Compressions and ventilations should be coordinated to avoid simultaneous delivery. • The chest should be permitted to reexpand fully during relaxation, but the rescuer’s thumbs should not leave the chest. • compressions to ventilations ratio 3:1 (i.e. ≈120 events/min to maximize ventilation at 90 compressions and 30 breaths
  • 62. • Thus each event will be allotted ≈1/2sec, with exhalation occurring during the first compression after each ventilation. • A 3:1 compression to ventilation ratio is used where ventilation compromise is the primary cause, but rescuers should consider using higher ratios (eg, 15:2) if the arrest is believed to be of cardiac origin.
  • 63. • Respirations, HR and oxygenation should be reassessed periodically, and coordinated chest compressions and ventilations should continue until the spontaneous HR ≥60/min. • Avoid frequent interruptions of compressions, as they will compromise artificial maintenance of systemic perfusion and maintenance of coronary blood flow.
  • 64. • If the neonate's condition does not improve rapidly with ventilation and tactile stimulation, an umbilical artery catheter should be inserted. • Most preterm neonates weighing < 1250 gram at birth and 1-3% of term neonates require an umbilical artery catheter during resuscitation.
  • 65. Umbilical venous catheter (UVC) • Most rapidly accessible intravascular route ▫ to administer drugs (Adrenaline); ▫ for fluid administration to expand blood volume, ▫ to measure blood gase, pH and arterial BP, • Provide continued vascular access until an alternative route is established
  • 66. RESUSCITATION DRUGS • Bradycardia is usually the result of inadequate lung inflation or profound hypoxemia, and establishing adequate ventilation is the most important step. • if the HR remains < 60/min despite one minute of adequate ventilation and chest compressions with100% O2,adrenaline or volume expansion or both are indicated
  • 67. • IV is the preferred route: UVC is preferable to intraosseous • Recommended IV dose is 0.01-0.03 mg/kg/dose; rapid bolus followed by 1ml of 0.9% NS flush
  • 68. •Intratracheal dose is higher(0.05 to 0.1 mg/kg); 1:10,000 (0.1 mg/mL); may be considered while IV access is being obtained; Follow with PPV – Flush not recommended •Can be repeated every 5 minutes, if HR remains < 60/min.
  • 69. Volume Expansion Detection of Hypovolemia • measuring the arterial BP and • by physical examination (i.e. pale skin color, have poor capillary refill time, poor skin perfusion, extremities are cold, and pulses (radial and posterior tibial) are weak or absent, and temperature).
  • 70. • CVP measurements are helpful in detecting hypovolemia and in determining the adequacy of fluid replacement. • Normal CVP in neonates is 2-8 cm H2O. • If CVP < 2 cm H2O, hypovolemia suspected.
  • 71. Treatment of Hypovolemia • The key is intravascular volume expansion. • Best be done with blood and crystalloids • If hypovolemia is suspected at birth, Rh- negative type O PRBCs should be available in delivery room before neonate is born.
  • 72. • Crystalloid and blood should be titrated in 10 mL/kg and given slowly over 10 minutes. • At times, >50% of the blood volume (85 mL/kg in term; and 100 mL/kg in preterm) must be replaced, especially when the placenta is transected or abrupted. • In most cases, <10-20 mL/kg of volume restores mean arterial pressure to normal.
  • 73. • Care should be taken to avoid giving volume expanders rapidly, because rapid infusions of large volumes have been associated with hypertension and IVH. • Hypertension may disrupt the intracerebral vessels and cause intracranial hemorrhage if cerebrovascular autoregulation is absent.
  • 74. Postresuscitation Care • Babies who require resuscitation are at risk for deterioration after their vital signs have returned to normal. • Once adequate ventilation and circulation have been established, the infant should be maintained in, or transferred to an environment where close monitoring and anticipatory care can be provided.
  • 75. Monitoring required may include: • Oxygen saturation(SpO2) • Heart rate and ECG • Respiratory rate and pattern • Blood glucose measurement • Blood gas analysis • Fluid balance and nutrition • Blood pressure • Temperature • Neurological
  • 76. Role of Glucose • Newborns with lower blood glucose levels are at ↑ risk for brain injury so maintain BGL >2.5 mmol/L. • If the blood glucose concentration is low, bolus of glucose (0.5 to 1.0 mL/kg of 10% dextrose) and constant infusion of 5-7 mg/kg/min intravenously is given .
  • 77. Induced Therapeutic Hypothermia • Infants born ≥36 weeks gestation with evolving moderate to severe hypoxic- ischemic encephalopathy should be offered therapeutic hypothermia (33.5-34.5⁰C). • The treatment according to the studied protocols include commencement within 6 hrs following birth, continuation for 72 hrs, and slow rewarming over at least 4 hours.
  • 78. Guidelines for Withholding and Discontinuing Resuscitation • It is based on the physician's experience and desires of the parents. • In making the decision, the physician must consider the probability of neurologic damage and chances of a productive, useful life are poor, consideration should be given to discontinuing all resuscitative efforts.
  • 79. Withholding Resuscitation • It may be considered reasonable, when there have been conditions with poor outcome (i.e. gestation, birth weight, or congenital anomalies are associated with almost certain early death or unacceptably high morbidity is likely among the rare survivors) and opportunity for parental agreement, (eg <23 wk gestation; BW<400g; trisomy 13)
  • 80. • conditions with ↑rate of survival, acceptable morbidity (with ≥ 25 wks gestation and with most congenital malformations, resuscitation is always indicated. • Conditions with borderline survival, high morbidity rate and uncertain prognosis, parental desires concerning initiation of resuscitation should be supported.
  • 81. Discontinuing Resuscitative Efforts • In a newly born baby with no detectable HR, resuscitation are discontinued if the HR remains undetectable for 10 min. • resuscitation efforts beyond 10 min with no HR should be considered if presumed etiology of the arrest, gestation of the baby, and the parental desire.
  • 82. LETS GIVE OUR NEWBORN A GOODSTART! Thanks……..
  • 83. Risk factors for neonatal resuscitation Maternal • PROM (> 18 hours) • Bleeding in 2nd or 3rd trimester • PIH • Substance abuse • Drug • Diabetes mellitus • Chronic illness • Maternal pyrexia • Maternal infection • Chorioamnionitis • Heavy sedation • Previous fetal or neonatal death Fetal •Multiple gestation •gestation (< 35 wks; >41 wks) •Large for dates •IUGR •Alloimmune haemolytic disease •Polyhydramnios and oligohydramnios •Reduced fetal movement before onset of labour •Congenital abnormalities which may effect breathing, cardiovascular function or other aspects of perinatal transition •Intrauterine infection •Hydrops fetalis Intrapartum •Non reassuring FHR patterns on CTG •Abnormal presentation •Prolapsed cord •Prolonged labour •APH(e.g. abruption, placenta praevia, vasa praevia) •Meconium in the amniotic fluid •Narcotic administration to mother within 4 hours of birth •Forceps birth •Vacuum-assisted (ventouse) birth •Maternal GA

Notas del editor

  1. Assists babies who fail to initiate or sustain regular breathing at birth.
  2. 2 vital characteristics.
  3. Suctioning of the oropharynx before delivery of the shoulders was considered routine until a randomized controlled trial demonstrated it to be of no value Elective and routine endotracheal intubation and direct suctioning of the trachea were initially recommended for all meconium-stained newborns until a randomized controlled trial demonstrated that there was no value in performing this procedure in babies who were vigorous at birth
  4. However, if attempted intubation is prolonged and unsuccessful, bag-mask ventilation should be considered, particularly if there is persistent bradycardia.
  5. So skin colour is a poor indicator of resuscitation need in immediate neonatal period.
  6. An initial peak inflation pressure of 20 cm H2O is effective, but 30-40 cm H2O may be required in some term babies without spontaneous ventilation.
  7. The laryngeal mask has not been evaluated in cases of meconium-stained fluid, during chest compressions, or for administration of emergency intratracheal medications.
  8. Drugs are rarely indicated in resuscitation of the newly born infant.
  9. 1-2 g/kg of 25% albumin, or 10 mL/kg of plasma.
  10. Care must be taken not to overexpand the intravascular volume and cause hypertension, especially in preterm neonates.