Newborn Resuscitation.ppt

Resuscitation of the
newborn baby

Learning objectives
 To assess a newborn baby at birth
 To perform basic resuscitation of a newborn
baby using standard equipment
 Resuscitation in special situations: meconium
stained liquor and preterm birth
 To learn principles of aftercare for a baby who
requires resuscitation at birth
Teaching Aids: ENC NH- 2

Resuscitation: Key words
 Anticipation
 Preparation
 Help
 Record
 Fast
 Gentle
 Warmth
 Hygiene
 Mother

Preparing for birth
Wash your hands
 Draught free, warm room - temperature >250C
 Clean, dry and warm delivery surface
 Radiant heater
 Two clean, warm towels/clothes
 A folded piece of cloth
 Self inflating bag - newborn size
 Infant masks in two sizes - normal and small newborn
 Suction device
 Oxygen (if available)
 Clock
Check if all equipments are in working order

Assessment at birth
 Deliver the baby on to mother’s abdomen
 Note and call out time of birth
 Thoroughly dry the baby
 Use a warm towel
 Discard wet towel after drying
 Wrap the baby in another warm cloth
Keep the baby warm
Assess breathing while drying

Care of the baby at birth
Assess breathing:
Assessment Decision
Baby is crying No need for resuscitation or
suctioning;
Start skin-to-skin contact and
breastfeeding
Baby is not crying, but breathing
at 30 to 60 times per minute
No need for resuscitation or
suctioning
Baby is gasping Start resuscitation immediately
Baby is not breathing Start resuscitation immediately

Scenario 1
A mother arrived at your maternity hospital and
delivered a baby girl as soon as she reached the
labor ward. The placenta followed the baby and
mother was not bleeding.
 The baby was pale. He was breathing and heart
rate was 120/min.
 What is the Action?

Dry the baby
immediately after
birth

Immediate
skin-to-skin
Contact &
Breastfeeding
(routine care)

Message 1
ONLY Routine care is required for a baby who is
crying or breathing normally;
Even routine suctioning is not required for these
normal babies

Scenario 2
A baby girl is born at your clinic after second stage of
60 minutes. The umbilical cord is short.
 You see that the skin is pale .She is not breathing.
Heart rate is over 100/min.

Steps of resuscitation
If the baby is not breathing or gasping
 Call for help!
 Cut cord quickly, transfer to a firm, warm
surface [under a radiant heater]
 Inform the mother that baby has difficulty
breathing and you will help the baby to breathe
 Start newborn resuscitation

Position, clear airways

Position, clear airways (if needed)
Suction: Do not exceed duration of 20 sec

Dry, stimulate, reposition

Selecting Bag & Mask
equipment
 Size of bag: 240-750 ml
 Oxygen capability: Oxygen
source, reservoir
 Safety feature: Pop off valve,
pressure gauge (optional)
Ventilate (if still not breathing)

Use the CORRECT size face
mask that covers:
The nose
The mouth
The tip of the chin
but not the eyes
Ventilate

Fitting a face mask:
 A face mask that is too LARGE
 Covers the eyes
 Extends over the tip of the chin
 A face mask that is too SMALL
 Does not cover the nose
 Does not cover the mouth effectively

 Squeeze bag with 2 fingers or whole
hand, 2-3 times
 Observe for rise of chest
 IF CHEST IS NOT RISING:
 Check seal
 Reposition the head
 Squeeze harder
 Once good seal and chest rising,
ventilate at 40 squeezes per minute
 Observe chest rise
 Check heart rate after 30 seconds
Ventilate

Message 2
Bag and mask ventilation is required for a baby
NOT BREATHING or GASPING

 If baby is crying;
 If breathing >30/min, and
 NO chest in-drawing:
 If the skin between the ribs is
‘sucked’ inwards and the ribs
are prominent, the baby has
chest ‘in-drawing’
When to stop ventilating?

 Put the baby in skin-to-skin contact on mother’s
chest
 Monitor every 15 minutes for breathing and
warmth
 Tell the mother the baby will probably be well
 Encourage the mother to start breastfeeding as
soon as possible
NEVER leave the baby alone
After stopping ventilation

If the baby
is breathing at a rate of <30/min,
is gasping
has severe chest in-drawing
 Arrange for immediate referral
When to continue ventilating?

 Explain to the mother what happened, that her
baby needs help with breathing
 Ventilate during the referral
 Record the event on a referral form and labour
record
If the baby is NOT breathing even after 20 minutes,
STOP ventilating
Referral

Scenario 3
Baby girl born at 38 weeks following thick
meconium stained amniotic fluid is noted
to be limp and not breathing .
 The baby is blue. She was not breathing and heart
rate was 80/min.

No need for intrapartum suction
Birth: assess
HR, breathing and tone
Vigorous: HR>100
good breathing
Good tone
Nonvigorous: any
parameter abnormal
Initial steps Tracheal suction

Message 3
 Meconium stained depressed baby needs
endotracheal suction prior to B&MV
 Routine suction of oro-pharynx is not
recommended before delivery of shoulder

Scenario 4
Mother admitted in maternity unit delivered a
baby boy at 32 week gestation on bed. The
baby is limp and not breathing.
 The baby is pale. He is not breathing and HR is
80/min.

 Be gentle
 Use small size resuscitation bag and give small tidal
volumes to move chest
 Avoid 100% oxygen , use blenders and oxygen
saturation monitors
 Avoid rapid fluid bolus
 May need intubation, chest compression, medications
 Keep CPAP back up ready
Special considerations for preterm

Message 4
Preterm births need special precautions before
and during resuscitation

Post resuscitation management
Principles
1. Keeping normal temperature
2. Maintaining oxygenation
3. Maintaining physiological milieu- fluids , glucose
4. Maintaining perfusion
5. Treating seizures
6. Monitoring organ function

Care after resuscitation
 Place baby in skin-to-skin contact with mother
 Keep the baby warm
 Monitor every 15 minutes
 Start breastfeeding as soon as possible
 Discuss what has happened with the parents - be
positive!
 Do not separate the mother and baby unless the baby
has difficult breathing

Summary: Steps of resuscitation
1. Keep the baby warm: Place under the radiant
heater
2. Open the airway:
- Position baby’s head so it is slightly extended
- Suction the mouth and then the nose
3. If still not breathing: VENTILATE
4. If breathing or crying begins: STOP
VENTILATION

Summary: Steps of resuscitation
5. If breathing at <30 breaths per minute or there
is severe chest in-drawing: CONTINUE
VENTILATION
6. If no breathing or gasping after 20 minutes of
ventilation: STOP VENTILATION
7. Explain events to the mother and document

Thank you,
God bless
you for
listening

Newborn Resuscitation.ppt

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