This is defined as a combination of hypoxemia, hypercapnia, and metabolic acidemia.
If lung expansion does not occur in the first few minutes following birth, and the infant is unable to establish ventilation and pulmonary perfusion, a progressive cycle of worsening hypoxemia, hypercapnia, and metabolic acidemia evolves.
Etiology Labor and delivery conditions Maternal conditions Fetal conditions
Early deceleration that occurs during the peak of uterine contractions and is due to pressure on the fetal head. (a repetitive pattern of slowing, synchronous with and proportional to the amplitude of the uterine contraction.
the degree of asphyxia. the need for immediate resuscitation. neonatal morbidity, the probability of successfully resuscitating an infant. every 5 minutes for a total of 20 minutes have been recommended to assess response and the appropriateness of continued resuscitative measures.
Mask ventilation— ( does not start to breathe, or if HR<100/min, or the color remains cyanotic) airway opened by placing the infant’s head in the neutral position. mask over mouth and nose. rate-40-60 breaths/min. pressure-to achive chest wall movement, the first few breaths may require higher pressures.
Intubation— ( if effective mask ventilation not established, intubate and start artificial ventilation) The laryngoscope blade is advanced to lift the epiglottis, as shown, and the laryngoscope is then lifted upwards. Gentle pressure on the trachea with the little finger or by an assistant helps bring the vocal cords into view.
External cardiac massage in a newborn infant External cardiac massage using with hands encircling the chest, the thumbs two fingers. on the sternum just below the nipple line. Circulation— external cardiac compression (start if pulse absent or heart rate <60 beats/min or 60-80 beats/min and not increasing) ratio of cardiac compression:lung inflation is 3:1
Drugs– (if bradycardia persists in spite of adequate ventilation and external cardiac compression) Adrenaline: 1:10000, 0.1 ml/kg via endotracheal tube Cannulate umbilical vein Adrenaline: 1:10000, 0.1ml/kg via umbilical vein Adrenaline: 1:10000, 0.3ml/kg via umbilical vein Repeat if necessary Sodium bicarbonate (1-2 mmol/kg) Volume expander (20ml/kg of 0.9% saline or blood if acute blood loss
Keep warm and dry Position,suction,stimulate Oxygen Establish effective ventiation : Mask ventilation Endotracheal ventilation Chest compression Drugs Always needed Rarely needed The inverted pyramid showing the relative frequency of procedures in neonatal resuscitation.
If clinical signs of increased intracranial pressure develop, a cranial - signs ultrasound should be performed to look for evidence of intraventricular or parenchymal hemorrhage, size of the lesion, generalized edema, or shift of the midline.
A head CT scan should be done if subdural hemorrhage is suspected, or if the cranial ultrasound study produces questionable findings.