3. OBJECTIVE
• To describe the steps of Positive Pressure Ventilation.
• To describe the indications for Endotracheal Intubation and Chest
Compressions.
• To discuss about the Medications used in NRP.
4. 4 key questions before birth:
( 1) What is the expected gestational age?
(2) Is the amniotic fluid clear?
(3) Are there any additional risk factors?
(4) What is our umbilical cord management plan?
5. INTRODUCTION
• Approximately 85% of term newborns will begin breathing-
spontaneously
• 10% will begin breathing - drying and stimulation.
6. INTRODUCTION
• 5% of term newborns - receive positive-pressure ventilation (PPV).
• 2% of term newborns -intubated.
• 1 to 3 babies per 1,000 births will receive chest compressions or
emergency medications.
8. NRP ALGORITHM
• It is divided into 5 blocks beginning with birth and the initial
assessment.
• Throughout the Algorithm, hexagons indicate assessments and
rectangles show actions that may be required.
10. RESUSCITATION TEAM
• Every birth should be attended by at least 1 qualified individual
• If risk factors are present, at least 2 qualified individuals should be
present.
12. ⦁ Anticipation
⦁ A radiant heat source ready for use
⦁ All resuscitation equipments immediately
available & in working order
⦁ At least 1 person skilled in neonatal
resuscitation
13. Neonatal Resuscitation Supplies & Equipments
-Suction Equipment
Mechanical suction
Suction catheters 10,12, or 14 F
Meconium aspirator
-Bag and Mask Equipment
Neonatal resuscitation bags ( self limiting)
Face-masks ( for both term & preterm babies)
Oxygen with flow meter and tubing
-Intubation Equipment
Laryngoscope with straight blades no.0 (preterm)& no.1 (term)
Extra bulbs & batteries ( for laryngoscope)
Endotracheal tubes ( int diameter 2.5, 3, 3.5 & 4)
14. Medications
Epinephrine
Normal saline or Ringer Lactate
Naloxone hydrochloride
Miscellaneous
Linen, shoulder roll, gauze
Radiant warmer
Stethoscope
Syringes 1,2,5,10,20,50 ml
Feeding tube 6 F
Umbilical catheters 3.5, 5 F
Three way stopcocks
Gloves
15. RAPID EVALUATION
High risk newborn: preterm,
poor tone, not crying
Low risk newborn:
Term,
good tone,
crying
16. INITIAL STEPS
• Provide warmth
• Dry
• Stimulate
• Positioning the head and neck
( to maintain patency of airway)
• Clearing the airway of secretions if needed
Vigorous term newborn – Skin to skin with
mother while initial steps are performed
17. INITIAL STEPS
• Gentle suctioning
• Mouth before Nose (M before N)
• Suction catheter – Negative pressure
80 – 100mmHg
19. INITIAL STEPS -EVALUATION
• Auscultation
Measure for 6 seconds and
multiply by 10.
If heart rate not determined by
physical examination -
Pulse oximeter or cardiac monitor
23. LABORED BREATHING? - YES
• Laboured breathing or oxygen saturation cannot be maintained within
target range despite oxygen.
• Trial of CPAP via Flow- inflating bag or T- piece.
30. MR SOPA
• 5 rescue breaths with each step to assess chest movement with PPV.
• Mask readjustment
+
Reposition the head and neck
• Suction the mouth and nose
+
Open the mouth
• Pressure increase
• Alternate airway
35. MEDICATIONS
• If HR < 60bpm
1. Continue co- ordinated PPV and CC
2. Access Umbilical venous line
3. Injection Adrenaline 1:10000 dilutions of 0.2ml/kg (0.1 – 0.3) followed by
saline flush of 3ml. Every 3-5 minutes.
4. ET adrenaline may be administered at a dose of 1.0ml/kg till umbilical
venous access is established
37. • No response to adrenaline
1. Consider discontinuing resuscitation, if HR = 0 after 20 minutes of
life.
2. Post – resuscitation debriefing and family counselling.
38. TAKE HOME MESSAGES
• Newborn resuscitation requires anticipation and preparation by
providers who train individually and as teams.
• Ventilation of the newborn's lungs is the single most important
and effective step in neonatal resuscitation.
• A rise in heart rate is most important indicator of effective ventilation
and response to resuscitative interventions.