2. Is an intervention after a baby is born to help it breath and
help heart beat
Resuscitation is helping with airway, breathing & circulation
AKA ABCs
INDICATIONS
Inadequate or ineffective respiration
Inadequate heart rate
Central cyanosis
3. EQUIPMENTS
Clock
Warm dry towels
Bag & masks
Firm stable surface
Gas supply and blow off valve Esp. oxygen
Face masks and tracheal tubes
Suction equipment's
5. Here is a summary of the logical approach to the baby not breathing at birth.
All babies are small and wet at delivery and therefore all babies will require
immediate attention to prevent them getting cold. This is true even in babies
needing urgent resuscitation.
During this time one can briefly assess whether this baby needs any further
attention.
Emphasise drying the baby. Most babies need simple things done well.
6. Babies are small and wet
They get cold very quickly
Dry the baby and then
cover with warm dry towels
7. • Start the clock
• Dry the baby
• Assess
Do you need help??.......................
Initial assessment
• Colour
• Tone
• Breathing
• Heart rate
8. Blue Pink
Good tone
Breathing regularly
Fast heart rate
Dry and cover
Give to Mum
9. Blue
Moderate tone
Breathing inadequately
Slow heart rate
Dry and cover
Open the airway
Inflation breaths?
10. Blue or pale
Floppy
Not breathing
Slow or very slow heart rate
Dry and cover
Open the airway
Inflation breaths
Re-assess
Do you need help ?
11. In the unconscious baby airway
obstruction is usually due to
loss of pharyngeal tone
NOT
foreign material in the airway i.e POSITION NOT SUCTION
12. • Hold head in neutral position
• Consider jaw thrust when necessary
• Give inflation breaths
13.
14. Here the anaesthetist has
applied a well fitting mask to
the baby’s face and is
supporting the baby’s chin
with his middle finger
15. Inflation breaths
Five breaths,
each sustained for 2-3 seconds
at 30 cm of water pressure
A long inflation time is needed for the first few breaths to ensure inflation /
aeration of the lungs
16. Give inflation breaths then
Reassess
What would you hope to find ?
an Increase in HEART RATE
Mask inflation is
nearly always effective
Only about 1 in 500
appear to need intubation
17. About 95% of babies for whom help is called
will recover within a minute or two
once air enters the lungs
If the heart rate responds
you can assume
the lungs have been inflated
Keep checking the heart rate to ensure that it remains above 100…
18. If the heart rate does not respond to inflation breaths then:-
Either You have NOT inflated the lungs
Or The heart needs help to respond
HOW CAN YOU TELL WHICH IS TRUE ?
19. If the lungs are being inflated then the chest will move with each inflation
breath
If the chest is not moving the lungs are not being inflated
Check A & B
21. If you don’t have a
second person
available you may find
that a Guedel airway is
helpful.
22. Another possibility is that the airway may be blocked with meconium or a
blood clot or some other foreign body.
Look with a laryngoscope.
Anything capable of blocking the airway will need a large bore sucker to
remove it.
Suction under direct vision
23. The heart rate has increased
and is now above 100…
but the baby is not breathing
Ventilate at ~ 30 breaths per minute
until the baby is breathing well
24. What if
…. the chest IS moving
but the heart rate is still slow
Consider chest compressions
25. Chest compression
You want to move oxygenated blood from the lungs to the coronary arteries
It’s not that far and won’t take long
26. This is a practical skill which will be taught in the skill stations.
In the new ADULT resuscitation guidelines even more emphasis has been
put on chest compressions. This is because an adult with a cardiac arrest will
usually have lungs which already contain air. Also they are not usually
grossly acidotic at the time of collapse.
At birth, on the other hand, babies will have lungs full of fluid and will already
be grossly acidotic if they are in serious difficulties. Massaging more
unoxygenated blood around the place will do nothing.
The lungs MUST BE INFLATED FIRST.
Also you are not trying to maintain brain perfusion you are just trying to
return oxygenated blood back to a healthy heart
27. Reasses
Has the heart rate improved ?
No
Check airway
Chest movement
Chest compression
Most babies who actually need chest compressions will respond with an
increase in heart rate within less than half a minute.
28. If they don’t you should go back and check that the airway really is open, that
the lungs really have been inflated and that chest compressions are really
being given effectively.
If all of these are true and there is STILL no response then the baby is in
serious trouble.
It might be worth considering drugs.
29. • Bicarbonate, Adrenaline, Dextrose, Atropine
If drugs really are necessary then the prognosis is poor.
There is a lot of anecdotal evidence of good outcome following the giving of
drugs in resuscitation but it is far from certain that the babies in question
really needed drugs.
Many would probably have responded to ABC if it had been well applied.
There is no firm scientific evidence supporting any particular order for the
administration of drugs..
30. The mnemonic merely emphasises that this is a bad place to be.
Bicarbonate, adrenaline and dextrose may all have a role.
Only adrenaline may be given down the tracheal tube but its effectiveness
through lungs recently filled with fluid is unknown.
Otherwise drugs require central venous access via a UVC. Peripheral access
is pointless if the circulation is at a standstill.
Volume is often given but rarely needed
31. REASSESSMENT
Remember temperature control. Continually reassess the baby as he
recovers. Remember that a small or scrawny baby, or even a well grown
baby, may have used up much of its reserves during this episode and may
later be unable to maintain a normal blood sugar without some intravenous
glucose.
Parents – explain what has happened and be prepared for questions. Don’t
try to bluff your way. If you don’t know the answer to their questions find
someone senior who does.
Records should contain times of events wherever possible. State the facts.
Do not add your interpretations or opinions. Don’t use terms like ‘birth
asphyxia’ or ‘fetal distress’.
32. No heart rate after 10 minutes of continuous good quality
resuscitation
Dry & cover the baby
Assess the situation
Airway
Breathing - Inflation breaths
Chest compressions
(Drugs)
