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Neonatal resuscitation guidelines 2015


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Newer guidelines on neonatal resusitation

Published in: Health & Medicine

Neonatal resuscitation guidelines 2015

  1. 1. Neonatal Resuscitation GuidelinesWhat's new???? Dr Aakash Pandita DNB Neonatology Fernandez Hosipital
  2. 2. • Introduction • Preparation /Anticipation • Initial assessment • Whom to resuscitate • Steps of resuscitation • New additions • Conclusion
  3. 3. Introduction • Approximately 10% of newborn's require some assistance. • Less than 1% require extensive resuscitation measures Because of the large total number of births, a significant number will require some degree of resuscitation
  4. 4. Anticipate the risk • Assessment of perinatal risk factors • Assemble the appropriate personnel • Organize access to supplies and check equipment • Effective teamwork and communication
  5. 5. Initial Assessment? • Assess the answers to the following 3 questions: • Term gestation? • Good tone? • Breathing or crying
  6. 6. Whom to resuscitate? • If the answer to any of these assessment questions is “NO” • A. Initial steps of stabilization • B. Ventilate and oxygenate (HR/Breathing) • C. Initiate chest compressions (HR < 60) • D. Administer epinephrine and/or volume
  7. 7. Approximately 60 seconds (“the Golden Minute”) are allotted for completing initial steps, revaluating and beginning ventilation if required
  8. 8. New Entries Umbilical cord management DCC : less IVH, higher BP, blood volume, less need for transfusion after birth, and less NEC No evidence of decreased mortality or decreased incidence of severe IVH slightly increased level of bilirubin associated with more need for phototherapy
  9. 9. New Entries Consensus: • DCC > 30 seconds is reasonable for both T/PT infants who do not require resuscitation at birth • No routine use of cord milking for infants < 29 weeks of gestation outside of a research setting
  10. 10. New Entries Temperature regulation • Admission temperature strong predictor of mortality at all gestational ages. • Hypothermia increases risk of IVH, respiratory issues, hypoglycaemia and late-onset sepsis predictor of outcomes as well as a quality indicator
  11. 11. New Entries Consensus • Maintain temperature between 36.5-37.5°C • Plastic wrap, radiant warmer, thermal mattress, warm humidified gases and increased room temperature • Hyperthermia (>38.0°C) should be avoided • Rapid or slow cooling both acceptable
  12. 12. New Entries Maintaining normothermia in resource-limited settings • Clean food-grade plastic bag up to the level of the neck and swaddle them after drying • Kangaroo mother care
  13. 13. New Entries Maternal hyperthermia in labour is associated with increased mortality, neonatal seizures and encephalopathy
  14. 14. New Entries Meconium Stained Amniotic Fluid • Deterioration of pulmonary compliance, oxygenation and cerebral blood flow velocity accompany tracheal suction Non vigorous baby: Routine intubation for tracheal suction not suggested
  15. 15. New Entries Assessment of Heart Rate • Increasing heart rate is most sensitive indicator of a successful response to each intervention • Underestimation of the newborn’s heart rate by auscultation, palpation and pulse oximetry • 3-lead ECG displayed a reliable heart rate faster than pulse oximetry
  16. 16. New Entries Consensus During resuscitation of T/PT newborn's, use 3-lead ECG for the rapid and accurate measurement of the newborn’s heart rate
  17. 17. New Entries Administration of oxygen in Preterm • Resuscitation of PT newborn's (<35) with high oxygen (65%) showed no improvement in survival to hospital discharge Resuscitate preterm < 35 weeks with low oxygen (21-30%) and titrate to achieve preductal oxygen saturation
  18. 18. New Entries Positive Pressure Ventilation/PEEP • PEEP :supplementary oxygen required to achieve target oxygen saturation may be slightly less when using PEEP. 5 cm H2O PEEP when PPV is administered to preterm newborn's PPV delivered effectively with a flow-inflating bag, self-inflating bag or T-piece resuscitator
  19. 19. New Entries • Use of respiratory mechanics monitors have been reported to prevent excessive pressures and tidal volumes • Exhaled CO2 monitors may help assess that actual gas exchange is occurring during face-mask PPV attempts. Effectiveness, particularly in changing important outcomes, has not been established
  20. 20. New Entries LMA recommended during resuscitation > 34 weeks when tracheal intubation is unsuccessful or is not feasible
  21. 21. New Entries • CPAP decreases rate of intubation, duration of MV with potential benefit of reduction of death and/or BPD without significant increase in air leak or severe IVH. spontaneously breathing PT infants with respiratory distress may be supported with CPAP initially rather than routine intubation for administering PPV
  22. 22. New Entries Chest compression 100% Oxygen whenever chest compressions are provided Supplementary oxygen concentration should be weaned as soon as the HR recovers
  23. 23. • In asystolic /bradycardic neonates no routine use of any single feedback device (ETCO2 monitors/pulse oximeters) for detection of return of spontaneous circulation • Usefulness has not been well established
  24. 24. New Entries Induced Therapeutic Hypothermia (Resource Limited setting) TH may be considered and offered under clearly defined protocols similar to those used in published clinical trials and in facilities with the capabilities for multidisciplinary care and longitudinal follow-up
  25. 25. New Entries Withholding Resuscitation • < 25 weeks, consider accuracy of gestational age assignment, presence/absence of chorioamnionitis and the level of care • Useful data for antenatal counselling provides outcome figures for infants alive at the onset of labor, not only for those born alive or admitted to a neonatal intensive care unit
  26. 26. Structure of educational programs to teach neonatal resuscitation • Advantages in psychomotor performance, knowledge and confidence when focused training occurred every 6 months or more frequently. Neonatal resuscitation task training should occur more frequently than the current 2-year interval
  27. 27. Any Questions???