NEW BORN RESUSCITATION &   MECONIUM ASPIRATION     Dr. G GANGADHAR RAO               GUNTUR MEDICAL COLLEGE  FORMER PAEDIA...
DR.GANGADHAR RAO G   2    M09493864912
MECONIUM ASPIRATION           SYNDROMEMortality and morbidity is 28% to 40% of MAS.INCIDENCE IS 8.8%, USUALLY POSTMATURE I...
What is Meconium?• In Greek - means "Poppy juice".• Black Green, Thick sticky odorless and acidic                     DR.G...
Contents• Water 72%-80%                 •   Proteins• Intestinal secretions         •   Lipids 8% dry wt.• Epithelial cell...
DR.GANGADHAR RAO G   6    M09493864912
Pathogenesis• Bile salts are blamed for. Exact cause unknown.• Inflammatory response by lung tissue.                    DR...
Introduction•   Cause of Respiratory failure in newborn.•   Inhalation of Meconium causes respiratory distress.•   Degree ...
Incidence•   Amniotic fluid stained in 16.5% (India)•   MAS develop in 18.7%•   MAS 1.44% in all births•   No seasonal var...
Definition•   Meconium below the vocal cords.•   Mild MAS < 40% Oxygen needed for < 48 hrs.•   Moderate MAS > 40% Oxygen n...
Working definition• Staining of Liquor Umbilical cord. Skin and nail.• Respiratory distress after 1 hr of birth.• Radiolog...
Causes in-utero• Meconium staining rarely  before 38wt• Levels of motilin• Maturity of myelination of                     ...
Risk factor• Maternal hypertension and diabetes mellitus• Maternal heavy smoking.• Chronic Respiratory and CVS disease.• P...
Mechanism of injury1.    Mechanical Obstruction.2.    Pneumothorax – “Ball Valve”.3.    Pneumonitis     1.   Bile salts   ...
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 an...
Clinical Features - Contd..CVS    1. Hypoxic myocardial damage.       2. Hypotension       3. CCF       4. S2 may be singl...
DR.GANGADHAR RAO G   18    M09493864912
Complications•   Pneumothorax•   Pneumomediastenum•   Pneumopericardium•   Pneumoperitonium•   Subcutaneous Emphysema•   B...
DR.GANGADHAR RAO G   20    M09493864912
Diagnosis• Meconium stained amniotic     fluid (MSAF)• Presence of meconium in trachea.• Radiological features.  Always su...
Investigations•   Hb % normal•   White cell count R•   Thrombocytopenia with PPH•   Disseminated Intravascular coagulation...
DR.GANGADHAR RAO G   23    M09493864912
Radiology  Use: Determine the extent of intrathoracic  pathology• Identify areas of atelectasis and air block  syndromes.•...
Radiology - Contd..•   Patchy infiltrates.•   Increased anterioposterior diameter.•   Atelectasis.•   Flattening of diaphr...
DR.GANGADHAR RAO G   26    M09493864912
Management• Minimal handling• Routine care – Thermal environment, hydration, oxygen.• Suction of oropharynx every 30 min• ...
DR.GANGADHAR RAO G   28    M09493864912
Prevention• Optimum Antenatal care• Risk factors for MAS• Monitoring of foetal heart for foetal distress• Foetal scalp blo...
DR.GANGADHAR RAO G   30    M09493864912
Prevention contd.  Intrapartum MSAF present:• Aspirate oropharynx first then nasopharynx after  the birth of head.• Assess...
ClassificationVigorous Newborn:              Non Vigorous Newborn:• Strong spontaneous Resp.       Airway suction   Effort...
DR.GANGADHAR RAO G   33    M09493864912
DR.GANGADHAR RAO G   34    M09493864912
DR.GANGADHAR RAO G   35    M09493864912
DR.GANGADHAR RAO G   36    M09493864912
DR.GANGADHAR RAO G   37    M09493864912
DR.GANGADHAR RAO G   38    M09493864912
DR.GANGADHAR RAO G   39    M09493864912
NEW BORN RESUSCITATION                Intubate• Suction through Intubation tube.• Continue tracheal aspiration with meconi...
DR.GANGADHAR RAO G   41    M09493864912
DR.GANGADHAR RAO G   42    M09493864912
DR.GANGADHAR RAO G   43    M09493864912
DR.GANGADHAR RAO G   44    M09493864912
DR.GANGADHAR RAO G   45    M09493864912
DR.GANGADHAR RAO G   46    M09493864912
DR.GANGADHAR RAO G   47    M09493864912
DR.GANGADHAR RAO G   48    M09493864912
DR.GANGADHAR RAO G   49    M09493864912
Do’s1.   Oropharyngeal suction at perineum in all MSAF babies.2.   Intrapartum fetal heart rate monitoring in all MSAF    ...
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,    ...
CH CRPF PHOTOES – (SEE FILE)          DR.GANGADHAR RAO G   53              M09493864912
DR.GANGADHAR RAO G   54    M09493864912
DR.GANGADHAR RAO G   55    M09493864912
DR.GANGADHAR RAO G   56    M09493864912
DR.GANGADHAR RAO G   57    M09493864912
DR.GANGADHAR RAO G   58    M09493864912
DR.GANGADHAR RAO G   59    M09493864912
DR.GANGADHAR RAO G   60    M09493864912
DR.GANGADHAR RAO G   61    M09493864912
DR.GANGADHAR RAO G   62    M09493864912
DR.GANGADHAR RAO G   63    M09493864912
Thank you             Dr. G GANGADHAR RAO            STUDENT OF GUNTUR MEDICAL COLLEGE               FORMER PAEDIATRICIAN ...
Thank you             Dr. G GANGADHAR RAO            STUDENT OF GUNTUR MEDICAL COLLEGE               FORMER PAEDIATRICIAN ...
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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

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

  1. 1. 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
  2. 2. DR.GANGADHAR RAO G 2 M09493864912
  3. 3. 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
  4. 4. What is Meconium?• In Greek - means "Poppy juice".• Black Green, Thick sticky odorless and acidic DR.GANGADHAR RAO G 4 M09493864912
  5. 5. 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
  6. 6. DR.GANGADHAR RAO G 6 M09493864912
  7. 7. Pathogenesis• Bile salts are blamed for. Exact cause unknown.• Inflammatory response by lung tissue. DR.GANGADHAR RAO G 7 M09493864912
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. Pathophysiology DR.GANGADHAR RAO G 15 M09493864912
  16. 16. 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
  17. 17. 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
  18. 18. DR.GANGADHAR RAO G 18 M09493864912
  19. 19. 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
  20. 20. DR.GANGADHAR RAO G 20 M09493864912
  21. 21. Diagnosis• Meconium stained amniotic fluid (MSAF)• Presence of meconium in trachea.• Radiological features. Always suspect MAS in MSAF. DR.GANGADHAR RAO G 21 M09493864912
  22. 22. 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
  23. 23. DR.GANGADHAR RAO G 23 M09493864912
  24. 24. 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
  25. 25. 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
  26. 26. DR.GANGADHAR RAO G 26 M09493864912
  27. 27. 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
  28. 28. DR.GANGADHAR RAO G 28 M09493864912
  29. 29. 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
  30. 30. DR.GANGADHAR RAO G 30 M09493864912
  31. 31. 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
  32. 32. 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
  33. 33. DR.GANGADHAR RAO G 33 M09493864912
  34. 34. DR.GANGADHAR RAO G 34 M09493864912
  35. 35. DR.GANGADHAR RAO G 35 M09493864912
  36. 36. DR.GANGADHAR RAO G 36 M09493864912
  37. 37. DR.GANGADHAR RAO G 37 M09493864912
  38. 38. DR.GANGADHAR RAO G 38 M09493864912
  39. 39. DR.GANGADHAR RAO G 39 M09493864912
  40. 40. 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
  41. 41. DR.GANGADHAR RAO G 41 M09493864912
  42. 42. DR.GANGADHAR RAO G 42 M09493864912
  43. 43. DR.GANGADHAR RAO G 43 M09493864912
  44. 44. DR.GANGADHAR RAO G 44 M09493864912
  45. 45. DR.GANGADHAR RAO G 45 M09493864912
  46. 46. DR.GANGADHAR RAO G 46 M09493864912
  47. 47. DR.GANGADHAR RAO G 47 M09493864912
  48. 48. DR.GANGADHAR RAO G 48 M09493864912
  49. 49. DR.GANGADHAR RAO G 49 M09493864912
  50. 50. 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
  51. 51. DR.GANGADHAR RAO G 51 M09493864912
  52. 52. 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
  53. 53. CH CRPF PHOTOES – (SEE FILE) DR.GANGADHAR RAO G 53 M09493864912
  54. 54. DR.GANGADHAR RAO G 54 M09493864912
  55. 55. DR.GANGADHAR RAO G 55 M09493864912
  56. 56. DR.GANGADHAR RAO G 56 M09493864912
  57. 57. DR.GANGADHAR RAO G 57 M09493864912
  58. 58. DR.GANGADHAR RAO G 58 M09493864912
  59. 59. DR.GANGADHAR RAO G 59 M09493864912
  60. 60. DR.GANGADHAR RAO G 60 M09493864912
  61. 61. DR.GANGADHAR RAO G 61 M09493864912
  62. 62. DR.GANGADHAR RAO G 62 M09493864912
  63. 63. DR.GANGADHAR RAO G 63 M09493864912
  64. 64. 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
  65. 65. 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

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