SlideShare a Scribd company logo
1 of 65
Download to read offline
NEW BORN RESUSCITATION &
   MECONIUM ASPIRATION



     Dr. G GANGADHAR RAO
               GUNTUR MEDICAL COLLEGE

  FORMER PAEDIATRICIAN YASHODA HOSPITAL SEC.

      Department of Pediatrics
COMPOSITE HOSPITAL CRPF HYDERABAD
                 DR.GANGADHAR RAO G
                     M09493864912
                                               1
DR.GANGADHAR RAO G   2
    M09493864912
MECONIUM ASPIRATION
           SYNDROME
Mortality 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 injury
1.    Mechanical Obstruction.
2.    Pneumothorax – “Ball Valve”.
3.    Pneumonitis
     1.   Bile salts
     2.   Bile acids
     3.   Release of cytokines
4.    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 regurgitation

Abd    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
DR.GANGADHAR RAO G   23
    M09493864912
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
Classification
Vigorous 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
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 meconium
  aspiration till “little or no meconium is aspirated or
  heart rate indicates resuscitation”.
• Aspirate Gastric meconium
                                                    sev asthma.MP G




Last 4 slides          DR.GANGADHAR RAO G                         40
                           M09493864912
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’s

1.   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
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 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

More Related Content

Viewers also liked

Meconium Aspiration 2005
Meconium Aspiration 2005Meconium Aspiration 2005
Meconium Aspiration 2005Dang Thanh Tuan
 
New born resuscitation power point presentation
New born resuscitation power point presentationNew born resuscitation power point presentation
New born resuscitation power point presentationMahtab Alam
 
Mas ppt arif
Mas ppt arifMas ppt arif
Mas ppt arifArif Khan
 
MECONIUM ASPIRATION SYNDROME
MECONIUM ASPIRATION SYNDROMEMECONIUM ASPIRATION SYNDROME
MECONIUM ASPIRATION SYNDROMElingampelli
 
Meconium stained amniotic fluid aspiration syndrome
Meconium stained amniotic fluid aspiration syndromeMeconium stained amniotic fluid aspiration syndrome
Meconium stained amniotic fluid aspiration syndromeRusila Divere
 
Meconium stained amniotic fluid with meconium aspiration syndrome by uma
Meconium  stained amniotic fluid with meconium aspiration syndrome by umaMeconium  stained amniotic fluid with meconium aspiration syndrome by uma
Meconium stained amniotic fluid with meconium aspiration syndrome by umasurya720
 
Fever without a source in Pediatrics
Fever without a source in PediatricsFever without a source in Pediatrics
Fever without a source in PediatricsMedPeds Hospitalist
 
Neurocutaneous Markers and Congenital malformations - Dr. S. Srinivasan, Prof...
Neurocutaneous Markers and Congenital malformations - Dr. S. Srinivasan, Prof...Neurocutaneous Markers and Congenital malformations - Dr. S. Srinivasan, Prof...
Neurocutaneous Markers and Congenital malformations - Dr. S. Srinivasan, Prof...pediatricsmgmcri
 
An approach to a child with abnormal movement
An approach to a child with abnormal movementAn approach to a child with abnormal movement
An approach to a child with abnormal movementSunil Agrawal
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitationAhmad Aboaziza
 
Approach to a child with hematuria
Approach to a child with hematuriaApproach to a child with hematuria
Approach to a child with hematuriaSunil Agrawal
 
Assessment of development sunil
Assessment of development sunilAssessment of development sunil
Assessment of development sunilSunil Agrawal
 
Techniques of oxygen delivery
Techniques of oxygen deliveryTechniques of oxygen delivery
Techniques of oxygen deliverySunil Agrawal
 

Viewers also liked (20)

Meconium Aspiration 2005
Meconium Aspiration 2005Meconium Aspiration 2005
Meconium Aspiration 2005
 
New born resuscitation power point presentation
New born resuscitation power point presentationNew born resuscitation power point presentation
New born resuscitation power point presentation
 
Mas ppt arif
Mas ppt arifMas ppt arif
Mas ppt arif
 
Meconium
MeconiumMeconium
Meconium
 
MECONIUM ASPIRATION SYNDROME
MECONIUM ASPIRATION SYNDROMEMECONIUM ASPIRATION SYNDROME
MECONIUM ASPIRATION SYNDROME
 
Austin Pediatrics
Austin PediatricsAustin Pediatrics
Austin Pediatrics
 
Meconium stained amniotic fluid aspiration syndrome
Meconium stained amniotic fluid aspiration syndromeMeconium stained amniotic fluid aspiration syndrome
Meconium stained amniotic fluid aspiration syndrome
 
Meconium stained amniotic fluid with meconium aspiration syndrome by uma
Meconium  stained amniotic fluid with meconium aspiration syndrome by umaMeconium  stained amniotic fluid with meconium aspiration syndrome by uma
Meconium stained amniotic fluid with meconium aspiration syndrome by uma
 
Fever without a source in Pediatrics
Fever without a source in PediatricsFever without a source in Pediatrics
Fever without a source in Pediatrics
 
Neurocutaneous Markers and Congenital malformations - Dr. S. Srinivasan, Prof...
Neurocutaneous Markers and Congenital malformations - Dr. S. Srinivasan, Prof...Neurocutaneous Markers and Congenital malformations - Dr. S. Srinivasan, Prof...
Neurocutaneous Markers and Congenital malformations - Dr. S. Srinivasan, Prof...
 
An approach to a child with abnormal movement
An approach to a child with abnormal movementAn approach to a child with abnormal movement
An approach to a child with abnormal movement
 
MECONIUM STAINED LIQUOR
MECONIUM STAINED LIQUORMECONIUM STAINED LIQUOR
MECONIUM STAINED LIQUOR
 
Shoulder dystocia
Shoulder dystociaShoulder dystocia
Shoulder dystocia
 
Nrp 7th edition
Nrp 7th editionNrp 7th edition
Nrp 7th edition
 
Meconium aspiration syndrome
Meconium aspiration syndromeMeconium aspiration syndrome
Meconium aspiration syndrome
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitation
 
Approach to a child with hematuria
Approach to a child with hematuriaApproach to a child with hematuria
Approach to a child with hematuria
 
Assessment of development sunil
Assessment of development sunilAssessment of development sunil
Assessment of development sunil
 
Techniques of oxygen delivery
Techniques of oxygen deliveryTechniques of oxygen delivery
Techniques of oxygen delivery
 
RIPE 2012 Pediatrics OSCE
RIPE 2012 Pediatrics OSCERIPE 2012 Pediatrics OSCE
RIPE 2012 Pediatrics OSCE
 

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

Case on COVID-19 Coagulopathy.pptx
Case on COVID-19 Coagulopathy.pptxCase on COVID-19 Coagulopathy.pptx
Case on COVID-19 Coagulopathy.pptxaceforum
 
Central Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin Gaikwad
Central Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin GaikwadCentral Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin Gaikwad
Central Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin GaikwadSachin Gaikwad
 
Rhodococcus equi
Rhodococcus equiRhodococcus equi
Rhodococcus equitcrumph2
 
Fungal infection in ICU
Fungal infection in ICUFungal infection in ICU
Fungal infection in ICUSayantan Saha
 
Nuclear medicine radiology revision notes
Nuclear medicine radiology revision notesNuclear medicine radiology revision notes
Nuclear medicine radiology revision notesTONY SCARIA
 
a case study on burn injury / case presentation on burn injury
a case study on burn injury / case presentation on burn injury a case study on burn injury / case presentation on burn injury
a case study on burn injury / case presentation on burn injury martinshaji
 
All-trans retinoic acid related complications in a patient with acute promy...
All-trans retinoic acid related  complications in a patient with acute  promy...All-trans retinoic acid related  complications in a patient with acute  promy...
All-trans retinoic acid related complications in a patient with acute promy...Choying Chen
 
nonsyndromic orofacial cleft and palate
nonsyndromic orofacial cleft and palatenonsyndromic orofacial cleft and palate
nonsyndromic orofacial cleft and palatehad89
 
Pyogenic meningitis (nimhans)
Pyogenic meningitis (nimhans)Pyogenic meningitis (nimhans)
Pyogenic meningitis (nimhans)Pratik Kishore
 
Infectious Coryza
Infectious Coryza Infectious Coryza
Infectious Coryza Sakina Rubab
 

Similar to Pediatrics new born resuscitation dr.gangadhar rao g m+91 949 3864 912 (16)

Case on COVID-19 Coagulopathy.pptx
Case on COVID-19 Coagulopathy.pptxCase on COVID-19 Coagulopathy.pptx
Case on COVID-19 Coagulopathy.pptx
 
LAMP- Daignostic assay
LAMP- Daignostic assayLAMP- Daignostic assay
LAMP- Daignostic assay
 
Central Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin Gaikwad
Central Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin GaikwadCentral Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin Gaikwad
Central Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin Gaikwad
 
Malaria
MalariaMalaria
Malaria
 
Rhodococcus equi
Rhodococcus equiRhodococcus equi
Rhodococcus equi
 
Fungal infection in ICU
Fungal infection in ICUFungal infection in ICU
Fungal infection in ICU
 
Nuclear medicine radiology revision notes
Nuclear medicine radiology revision notesNuclear medicine radiology revision notes
Nuclear medicine radiology revision notes
 
a case study on burn injury / case presentation on burn injury
a case study on burn injury / case presentation on burn injury a case study on burn injury / case presentation on burn injury
a case study on burn injury / case presentation on burn injury
 
Infective endocarditis
Infective endocarditisInfective endocarditis
Infective endocarditis
 
All-trans retinoic acid related complications in a patient with acute promy...
All-trans retinoic acid related  complications in a patient with acute  promy...All-trans retinoic acid related  complications in a patient with acute  promy...
All-trans retinoic acid related complications in a patient with acute promy...
 
Cervix cancer iiib
Cervix cancer iiibCervix cancer iiib
Cervix cancer iiib
 
Chronic granulomatous diseases; a comprehensive care
Chronic granulomatous diseases; a comprehensive careChronic granulomatous diseases; a comprehensive care
Chronic granulomatous diseases; a comprehensive care
 
Phaeochromocytoma
PhaeochromocytomaPhaeochromocytoma
Phaeochromocytoma
 
nonsyndromic orofacial cleft and palate
nonsyndromic orofacial cleft and palatenonsyndromic orofacial cleft and palate
nonsyndromic orofacial cleft and palate
 
Pyogenic meningitis (nimhans)
Pyogenic meningitis (nimhans)Pyogenic meningitis (nimhans)
Pyogenic meningitis (nimhans)
 
Infectious Coryza
Infectious Coryza Infectious Coryza
Infectious Coryza
 

Recently uploaded

ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 

Recently uploaded (20)

ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 

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

  • 1. NEW BORN RESUSCITATION & MECONIUM ASPIRATION Dr. G GANGADHAR RAO GUNTUR MEDICAL COLLEGE FORMER PAEDIATRICIAN YASHODA HOSPITAL SEC. Department of Pediatrics COMPOSITE HOSPITAL CRPF HYDERABAD DR.GANGADHAR RAO G M09493864912 1
  • 2. DR.GANGADHAR RAO G 2 M09493864912
  • 3. MECONIUM ASPIRATION SYNDROME Mortality 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. What is Meconium? • In Greek - means "Poppy juice". • Black Green, Thick sticky odorless and acidic DR.GANGADHAR RAO G 4 M09493864912
  • 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. DR.GANGADHAR RAO G 6 M09493864912
  • 7. Pathogenesis • Bile salts are blamed for. Exact cause unknown. • Inflammatory response by lung tissue. DR.GANGADHAR RAO G 7 M09493864912
  • 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. 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. 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. 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. 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. 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. Mechanism of injury 1. Mechanical Obstruction. 2. Pneumothorax – “Ball Valve”. 3. Pneumonitis 1. Bile salts 2. Bile acids 3. Release of cytokines 4. Pulmonary Vasoconstriction. 5. Surfactant Inactivation. DR.GANGADHAR RAO G 14 M09493864912
  • 15. Pathophysiology DR.GANGADHAR RAO G 15 M09493864912
  • 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. Clinical Features - Contd.. CVS 1. Hypoxic myocardial damage. 2. Hypotension 3. CCF 4. S2 may be single 5. Murmur of tricuspid regurgitation Abd 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. DR.GANGADHAR RAO G 18 M09493864912
  • 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. DR.GANGADHAR RAO G 20 M09493864912
  • 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. 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. DR.GANGADHAR RAO G 23 M09493864912
  • 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. 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. DR.GANGADHAR RAO G 26 M09493864912
  • 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. DR.GANGADHAR RAO G 28 M09493864912
  • 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. DR.GANGADHAR RAO G 30 M09493864912
  • 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. Classification Vigorous 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. DR.GANGADHAR RAO G 33 M09493864912
  • 34. DR.GANGADHAR RAO G 34 M09493864912
  • 35. DR.GANGADHAR RAO G 35 M09493864912
  • 36. DR.GANGADHAR RAO G 36 M09493864912
  • 37. DR.GANGADHAR RAO G 37 M09493864912
  • 38. DR.GANGADHAR RAO G 38 M09493864912
  • 39. DR.GANGADHAR RAO G 39 M09493864912
  • 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 G Last 4 slides DR.GANGADHAR RAO G 40 M09493864912
  • 41. DR.GANGADHAR RAO G 41 M09493864912
  • 42. DR.GANGADHAR RAO G 42 M09493864912
  • 43. DR.GANGADHAR RAO G 43 M09493864912
  • 44. DR.GANGADHAR RAO G 44 M09493864912
  • 45. DR.GANGADHAR RAO G 45 M09493864912
  • 46. DR.GANGADHAR RAO G 46 M09493864912
  • 47. DR.GANGADHAR RAO G 47 M09493864912
  • 48. DR.GANGADHAR RAO G 48 M09493864912
  • 49. DR.GANGADHAR RAO G 49 M09493864912
  • 50. Do’s 1. 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. DR.GANGADHAR RAO G 51 M09493864912
  • 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. CH CRPF PHOTOES – (SEE FILE) DR.GANGADHAR RAO G 53 M09493864912
  • 54. DR.GANGADHAR RAO G 54 M09493864912
  • 55. DR.GANGADHAR RAO G 55 M09493864912
  • 56. DR.GANGADHAR RAO G 56 M09493864912
  • 57. DR.GANGADHAR RAO G 57 M09493864912
  • 58. DR.GANGADHAR RAO G 58 M09493864912
  • 59. DR.GANGADHAR RAO G 59 M09493864912
  • 60. DR.GANGADHAR RAO G 60 M09493864912
  • 61. DR.GANGADHAR RAO G 61 M09493864912
  • 62. DR.GANGADHAR RAO G 62 M09493864912
  • 63. DR.GANGADHAR RAO G 63 M09493864912
  • 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. 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