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Pediatrics new born resuscitation dr.gangadhar rao g m+91 949 3864 912
 

Pediatrics new born resuscitation dr.gangadhar rao g m+91 949 3864 912

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MEDICAL, HEALTH, PEDIATRICS NEWBORN RESUSCITATION BY DR G GANGADHAR RAO MOB.PHONE NO +91 9493 864912 EMAIL: doctorhyderabad@gmail.com

MEDICAL, HEALTH, PEDIATRICS NEWBORN RESUSCITATION BY DR G GANGADHAR RAO MOB.PHONE NO +91 9493 864912 EMAIL: doctorhyderabad@gmail.com

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    Pediatrics new born resuscitation dr.gangadhar rao g m+91 949 3864 912 Pediatrics new born resuscitation dr.gangadhar rao g m+91 949 3864 912 Presentation Transcript

    • NEW BORN RESUSCITATION & MECONIUM ASPIRATION Dr. G GANGADHAR RAO GUNTUR MEDICAL COLLEGE FORMER PAEDIATRICIAN YASHODA HOSPITAL SEC. Department of PediatricsCOMPOSITE HOSPITAL CRPF HYDERABAD DR.GANGADHAR RAO G M09493864912 1
    • DR.GANGADHAR RAO G 2 M09493864912
    • MECONIUM ASPIRATION SYNDROMEMortality and morbidity is 28% to 40% of MAS.INCIDENCE IS 8.8%, USUALLY POSTMATURE INFANTS,APGAR SCORE 1- 5 Min. IS LESS THAN 6 DR.GANGADHAR RAO G 3 M09493864912
    • What is Meconium?• In Greek - means "Poppy juice".• Black Green, Thick sticky odorless and acidic DR.GANGADHAR RAO G 4 M09493864912
    • Contents• Water 72%-80% • Proteins• Intestinal secretions • Lipids 8% dry wt.• Epithelial cells • Bile acids and salts• Swallowed Amniotic fluid • Enzymes• Mucopolysacchrides 80% • Blood substances of dry wt. • Squamous cells and• Cholesterol and Sterol Vernix caseosa. precursors DR.GANGADHAR RAO G 5 M09493864912
    • DR.GANGADHAR RAO G 6 M09493864912
    • Pathogenesis• Bile salts are blamed for. Exact cause unknown.• Inflammatory response by lung tissue. DR.GANGADHAR RAO G 7 M09493864912
    • Introduction• Cause of Respiratory failure in newborn.• Inhalation of Meconium causes respiratory distress.• Degree of severity vary.• Meconium in Amniotic fluid 10%-20% of total deliveries.• Mortality and morbidity in 28% to 40% of MAS. DR.GANGADHAR RAO G 8 M09493864912
    • Incidence• Amniotic fluid stained in 16.5% (India)• MAS develop in 18.7%• MAS 1.44% in all births• No seasonal variation DR.GANGADHAR RAO G 9 M09493864912
    • Definition• Meconium below the vocal cords.• Mild MAS < 40% Oxygen needed for < 48 hrs.• Moderate MAS > 40% Oxygen needed for > 48 hrs.• Severe MAS Ventilation > 48 hrs often with persistent pulmonary hypertension. DR.GANGADHAR RAO G 10 M09493864912
    • Working definition• Staining of Liquor Umbilical cord. Skin and nail.• Respiratory distress after 1 hr of birth.• Radiological features of Aspiration pneumonitis. DR.GANGADHAR RAO G 11 M09493864912
    • Causes in-utero• Meconium staining rarely before 38wt• Levels of motilin• Maturity of myelination of • Foetal distress – hypoxia gut • Diving reflex• Lack of strong peristalsis of gut • Umbilical cord compression• Good sphincter tone • Gut maturation• „Cap‟ viscous meconium in rectum • Breech presentation • Listeriosis in foetus – foetal diarrhoea DR.GANGADHAR RAO G M09493864912 12
    • Risk factor• Maternal hypertension and diabetes mellitus• Maternal heavy smoking.• Chronic Respiratory and CVS disease.• Post term pregnancy.• Pre eclampsia / Eclampsia.• Oligohydramnios.• Poor biophysical profile.• Foetal distress (Abnormal Heart Rate) DR.GANGADHAR RAO G 13 M09493864912
    • Mechanism of injury1. Mechanical Obstruction.2. Pneumothorax – “Ball Valve”.3. Pneumonitis 1. Bile salts 2. Bile acids 3. Release of cytokines4. Pulmonary Vasoconstriction.5. Surfactant Inactivation. DR.GANGADHAR RAO G 14 M09493864912
    • Pathophysiology DR.GANGADHAR RAO G 15 M09493864912
    • Clinical Features• Usually full term and post term• Signs of post maturity.• Green Yellow staining of nails, skin and umbilical cord.• Afebrile, Fever or hypothermia if infected.• Resp. rate > 120/min.• Subcostal, Intercostal and sternal retraction.• Use of accessory muscles• Flaring of nostrils• Grunt• Increased Ant. Post diameter• Apnoea• Rhonchi and crepitations. DR.GANGADHAR RAO G 16 M09493864912
    • Clinical Features - Contd..CVS 1. Hypoxic myocardial damage. 2. Hypotension 3. CCF 4. S2 may be single 5. Murmur of tricuspid regurgitationAbd 1. Distended (Aerophagia) 2. Liver and Spleen displaced. 3. Constipation. 4. Absent bowel sounds in severe cases. 5. Urinary retention.CNS: 1. Hypoxic ischemic Encephalopathy. 2. Signs of birth asphyxia. RAO G DR.GANGADHAR 17 M09493864912
    • DR.GANGADHAR RAO G 18 M09493864912
    • Complications• Pneumothorax• Pneumomediastenum• Pneumopericardium• Pneumoperitonium• Subcutaneous Emphysema• Broncho pulmonary Dysplasia• Persistent Pulmonary Hypertension• Pulmonary damage• Cerebral damage (Hypoxic)• Secondary Bacterial Infection• Renal Failure• Complication of intubation and ventilation DR.GANGADHAR RAO G 19 M09493864912
    • DR.GANGADHAR RAO G 20 M09493864912
    • Diagnosis• Meconium stained amniotic fluid (MSAF)• Presence of meconium in trachea.• Radiological features. Always suspect MAS in MSAF. DR.GANGADHAR RAO G 21 M09493864912
    • Investigations• Hb % normal• White cell count R• Thrombocytopenia with PPH• Disseminated Intravascular coagulation• PaCO2 Low – Normal - Raised• Metabolic acidemia• Culture for sepsis• Parameters of renal failure• Urine analysis – Normal except in renal failure• Color is Greenish brown due to Meconium pigment• ECG -Normal• ECHO – Reduced cardiac contractility DR.GANGADHAR RAO G 22 M09493864912
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    • Radiology Use: Determine the extent of intrathoracic pathology• Identify areas of atelectasis and air block syndromes.• Assure appropriate positioning of endotracheal tube and umbilical artery catheter. DR.GANGADHAR RAO G 24 M09493864912
    • Radiology - Contd..• Patchy infiltrates.• Increased anterioposterior diameter.• Atelectasis.• Flattening of diaphragm.• Retrosternal lucency.• Small pleural effusions in about 33% cases.• Pneumothorax and/or pneomediastinum in 25% cases.• Diffuse chemical pneumonitis• Cardiomegaly to be detected due to underlying perinatal asphyxia DR.GANGADHAR RAO G 25 M09493864912
    • DR.GANGADHAR RAO G 26 M09493864912
    • Management• Minimal handling• Routine care – Thermal environment, hydration, oxygen.• Suction of oropharynx every 30 min• Chest Physiotherapy• Correction of Acidosis• Monitor BP and Renal functions• Blood gas monitoring.• Ventilation IPPV 60-80 / min, CPPV – unusual.• IV tolazoline for PPHT• Antibiotic if infection suspected. DR.GANGADHAR RAO G 27 M09493864912
    • DR.GANGADHAR RAO G 28 M09493864912
    • Prevention• Optimum Antenatal care• Risk factors for MAS• Monitoring of foetal heart for foetal distress• Foetal scalp blood pH where possible• Expediate delivery if foetal distress• Avoid post maturity (more than 42 wt.)• Presence of two skilled persons in resuscitation for every delivery in labour room DR.GANGADHAR RAO G 29 M09493864912
    • DR.GANGADHAR RAO G 30 M09493864912
    • Prevention contd. Intrapartum MSAF present:• Aspirate oropharynx first then nasopharynx after the birth of head.• Assess the newborn after birth. DR.GANGADHAR RAO G 31 M09493864912
    • ClassificationVigorous Newborn: Non Vigorous Newborn:• Strong spontaneous Resp. Airway suction Effort Direct laryngoscopy and• Good muscle tone suction• Heart rate > 100/min• Monitor for MAS DR.GANGADHAR RAO G 32 M09493864912
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    • NEW BORN RESUSCITATION Intubate• Suction through Intubation tube.• Continue tracheal aspiration with meconium aspiration till “little or no meconium is aspirated or heart rate indicates resuscitation”.• Aspirate Gastric meconium sev asthma.MP GLast 4 slides DR.GANGADHAR RAO G 40 M09493864912
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    • Do’s1. Oropharyngeal suction at perineum in all MSAF babies.2. Intrapartum fetal heart rate monitoring in all MSAF babies.3. Anticipate passage of meconium or MAS during birth of all IUGR babies in the labor room.4. Skillful resuscitation and assistance are key points in management.5. Do intubate neonates born through MSAF who are depressed (non vigorous babies) at birth irrespective of consistency of meconium. DR.GANGADHAR RAO G 50 M09493864912
    • DR.GANGADHAR RAO G 51 M09493864912
    • Dont’s• Do not go by the consistency of meconium in management for intubation.• Do not apply cricoid pressure, chest compression or occlude airway by fingers to prevent initiation of respiration in MSAF babies.• Do not ignore the general condition of baby during intubation. DR.GANGADHAR RAO G M09493864912 Thank you 52
    • CH CRPF PHOTOES – (SEE FILE) DR.GANGADHAR RAO G 53 M09493864912
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    • Thank you Dr. G GANGADHAR RAO STUDENT OF GUNTUR MEDICAL COLLEGE FORMER PAEDIATRICIAN YASHODA HOSPITAL SEC. Department of Pediatrics COMPOSITE HOSPITAL CRPF HYDERABAD DR.GANGADHAR RAO G 64 M09493864912
    • Thank you Dr. G GANGADHAR RAO STUDENT OF GUNTUR MEDICAL COLLEGE FORMER PAEDIATRICIAN YASHODA HOSPITAL SEC. Department of Pediatrics COMPOSITE HOSPITAL CRPF HYDERABAD DR.GANGADHAR RAO G 65 M09493864912