emergency care at birth emergency care of newborn

1. SHARON TREESA ANTONY
FIRST YEAR M.SC NURRSING
GOVT. COLLEGE OF NURSING
KOTTAYAM

2. INDICATIONS
 Preterm delivery
 Delivery other than normal
 Malpresentations
 Multiple pregnancy
 Fetal distress
 Meconium staining
 Severe IUGR
 Antepartum haemorrhage
 Antenatal diagnosis of fetal abnormalities

3. PREREQUISITES

4. RESUSCITATION PLACE
 FLAT SURFACE
 Warm and clean
 Room temperature 26 degree celsius
 Radiant warmer/heater/a 200 watt bulb
 Keep heat source on before delivery
 2 pre warmed towels to receive the baby

5. EQUIPMENT
 Dee Lee Trap
 Mechanical suction
 Suction catheters (12 F and 14 F)
 Feeding tubes (6 F & 8 F) and 20 ml syringe
 Neonatal self inflating resuscitation bags( 500 ml)
 Face masks ( term and preterm size)
 Oxygen with flow meter and tubing

6.  Intubation equipment
 Laryngoscope with straight blade( No.0 preterm, No.1
term)
Extra bulbs and batteries
 Endotra cheal tubes (2.5, 3.0, 3.5)
• Resuscitation drugs and fluids
Inj epinephrine
Inj naloxone
Normal saline
Sterile water

7. GENERAL MEASURES

8. WARMTH
 AVOID HYPOTHERMIA
 Delivery in a warm and draft free area
 Baby received with a pre warmed towel
 Rapidly dry head and skin
 Discard wet linen
 Wrap in a pre warmed towel
 Place on firm surface under radiant warmer/ on mother’s
body

9. POSITIONING
 Supine with head in a neutral or slightly extended
position
 May keep towel under the shoulder

10. CLEAR THE AIRWAY
 By gentle suction SOS
 First the mouth then the nose
 Only for 2-3 sec
 Suction pressure < 100 mmHg
 Avoid deep suction

11. STIMULATION
 Flicking the toes and soles twice
 Rubbing the back
COMPLETE ALL THESE STEPS IN
30 SECONDS. IF BABY IS NOT
BREATHING GO FOR BMV

12. EVALUATION
 REASSESS every 30 sec
 Consider intubation if needed
 Evaluate RR, HR, colour
 HR by auscultation
 Count for 6 sec, then *10

13. PROVIDE OXYGEN
 If normal breathing and heart rate but blue limbs
 Free flow O2 at 5L/min
 By an O2 mask/ tubing
 Monitor SPO2

14. BAG AND MASK VENTILATION
 INDICATIONS
 Apnoea or gasping respiration
 Heart rate <100 bpm
 Persistent central cyanosis despite 100% O2

15.  PROCEDURE
 Apply the mask covering the chin upto the nose
 Resuscitator at the head end or side
 Rate : 40- 60 /min
 If along with chest compression, 30/ min
 Evaluate every 30 sec until HR >100 bpm
 If HR < 60 bpm : start chest compression
 If stomach distended, decompress it

16. Causes of non expansion of chest
 Blocked airways
 Leak in mouth seal
 Insufficient inflation

17. CHEST COMPRESSION
 TECHNIQUES
 Two thumb
 Two finger

18.  RATE : 90/ MIN
 COMPRESSION :VENTILATION RATIO : 3:1
 Evaluate HR after 30 sec
 Discontinue if HR > 60 bpm

19. ENDOTRACHEAL INTUBATION
 INDICATIONS
 Meconium stained baby
 Meconium aspiration
 No response to BMV
 Congenital Diaphragmatic Hernia
 When chest compression is done simultaneously
 For administration of drugs

20. ALGORITHM

22. DOCUMENTATION
 APGAR score
 Description of interventions with time

23. When to discontinue
 No HR for >10 min
When to with held
• Gestational age < 23 weeks
• Birth weight <400g
• Trisomy 13 or 18

24. MECONIUM STAINED LIQUOR
 BABY ACTIVELY CRYING
 ONLY suctioning of mouth and nose
 BABY DEPRESSED ON DELIVERY
 Avoid initial stimulation
 BMV is contraindicated
 Endo tracheal intubation and suctionif Hr falls during
suction, give PPV

25. CONGENITAL DIAPHRAGMATIC
HERNIA
 BMV contraindicated
 If medically stable go for surgery

26. THANK YOU