2. INTRODUCTION
APPROXIMATELY 10% OF TOTAL NEWBORNS
REQUIRE SOME ASSISTANCE TO BEGIN
BREATHING AT BIRTH.
LESS THAN 1% REQUIRE EXTENSIVE
RESUSCITATIVE MEASUREMENTS.
BASIC LIFE SUPPORT ARE NEEDED FOR THE
BABIES WHO ARE HAVING BIRTH ASPHYXIA.
3. DEFINITION
NEONATAL RESUSCITATION IS THE SERIES OF
ACTIONS, USED TO ASSIST NEW BORN
BABIES, WHO HAVE DIFFICULTY WITH MAKING
THE PHYSIOLOGICAL TRANSITION FROM THE
INTRAUTERINE TO EXTRAUTERINE LIFE
5. GOALS
THE MAIN GOALS OF NEONATAL RESUSCITATION
ARE –
1. TO INITIATE NORMAL BREATHING OF THE
BABY
2. TO MAINTAIN ADEQUATE TISSUE PERFUSION
3. TO RESTORE NORMAL CORE TEMPERATURE
4. TO MAINTAIN ADEQUATE CARDIAC OUTPUT
9. EQUIPMENTS
THE ESSENTIAL EQUIPMENTS WHICH ARE
USED FOR NEONATAL RESUSCITATION ARE –
1. SUCTION EQUIPMENTS
2. BAG AND MASK EQUIPMENTS
3. INTUBATION EQUIPMENTS
4. MEDICATIONS
5. FLUID EQUIPMENTS
6. MISCELLANEOUS
10. SUCTION
EQUIPMENTS
BULB SYRINGE
SUCTION CATHETER
SUCTION TUBING
MECONIUM ASPIRATOR
SUCTION APPARATUS
SYRINGE CATHETER ( 10 mL or 20
mL )
21. T STANDS FOR MAINTENANCE OF
TEMPERATURE
A STANDS FOR ESTABLISHMENT OF AN
OPEN AIRWAY
B STANDS FOR INITIATION OF
BREATHING
C STANDS FOR MAINTENANCE OF
TEMPERATURE
22. MAINTENANCE OF
TEMPERATURE
IT CAN BE DONE BY –
RECEIVING THE BABY IN A PREWARM
TOWEL
PROVISION OF HEAT SOURCES
DRYING THE BABY
REMOVING WET LINEN
23. ESTABLISHMENT OF AN OPEN
AIRWAY
IT CAN BE DONE BY –
1. PROPER POSITIONING THE INFANT
2. SUCTION THE MOUTH, NOSE. IN SOME
CASES TRACHEA TOO
3. IF NECESSARY, INSERT AN E.T. TUBE ALSO
24. INITIATION OF BREATHING
IT CAN BE DONE BY –
1. TACTILE STIMULATION
2. P.P.V. ( POSITIVE PRESSURE VENTILATION )
27. PROCEDURE
INITIAL STAGE –
1.RECEIVE THE BABY IN A PREWARMED
TOWEL
2.PLACE THE BABY IN A PREHEATED
WARMER
3. POSITION THE BABY ON BACK WITH THE
NECK SLIGHTLY EXTENDED ( SNIFFING
POSITION )
4.NO HYPEREXTENSION &
UNDEREXTENSION
28. CONT…..
5. SUCTIONING OF THE MOUTH SHOULD BE
DONE FIRST, THEN NOSE TO PREVENT THE
CHANCE OF ASPIRATION OF SECRETION BY
MOUTH
6. USE MECONIUM SUCCAR IN CASE OF
MECONIUM ASPIRATION
30. CONT…..
2. USING FREE FLOW OXYGEN –
BY BLOWING OVER THE NEONATE’S NOSE, SO
THAT THE BABY BREATHES OXYGEN
ENRICHED AIR.
FLOW SHOULD BE 5L / Min
IF THE BABY IS HAVING SPONTANEOUS
RESPIRATION, H.R. IS ABOVE 100 BEATS PER
MINUTE WITH SKIN COLOR PINK, THEN BABY
NEEDS ONLY OBSERVATION AND
MONITORING.
31. CONT…..
NOTE : -
IF THE BABY IS HAVING SPONTANEOUS
RESPIRATION, H.R. IS ABOVE 100
BEATS PER MINUTE WITH SKIN COLOR
PINK, THEN BABY NEEDS ONLY
OBSERVATION AND MONITORING
32. CONT…..
BAG & MASK VENTILATION –
SHOULD BE STARTED IF AFTER TACTILE
STIMULATION –
1. THE INFANT IS STILL APNEIC OR
GRASPING
2. HAVING SPONTANEOUS RESPIRATION
BUT H.R. IS BELOW 100 BEATS PER
MIN
33. CONT…..
FOR B.M.V. –
BABY’S NECK SHOULD BE SLIGHTLY
EXTENDED TO ENSURE OPEN AIRWAY
MASK TO BE PLACED IN POSITION WHICH
SHOULD COVER TIP OF THE CHIN,
MOUTH AND NOSE
VENTILATION SHOULD BE DONE AT THE
RATE OF 40 - 60 BR. PER MIN
35. CONT…..
FINDINGS
1. H.R > 100
BEATS/MIN
2. H.R. IS BETWEEN
60 – 100
BEATS/MIN
3. H.R. < 60
BEATS/MIN
INTERVENTIONS
1. STOP B.M.V. AND
MONITOR THE BABY
ONLY
2. CONTINUE B.M.V.
3. CONTINUE WITH
CHEST
COMPRESSION
36. CONT…..
CHEST COMPRESSION –
MUST BE PERFORMED ALONG WITH
VENTILATION AND 100% OXYGENATION
METHODS : -
IT CAN BE DONE BY TWO METHODS,
1. THUMB COMPRESSION
2. TWO FINGER TECHNIQUE
37. CONT…..
LOCATION :-
THE PRESSURE SHOULD BE APPLIED AT
THE LOWER THIRD OF THE STERNUM
DEPTH :-
THE DEPTH SHOULD BE ½ TO ¾ INCH.
RATE :-
THE RATE OF CHEST COMPRESSION WILL BE
90 COMPRESSIONS AT A MINUTE ALONG WITH
30 P.P.V.
TOTAL 120 EVENTS PER MINUTE
38. CONT…..
PATTERN :-
TWO PERSON SHOULD BE THERE
THREE COMPRESSIONS FOLLOWED BY
ONE VENTILATION
TIME DURATION :-
3 CHEST COMPRESSIONS SHOULD BE
DONE WITHIN 1.5 SECOND
1 VENTILATION SHOULD BE DONE
WITHIN 0.5 SECOND
39. CONT…..
4 EVENTS ( 3 COMPRESSIONS + 1 P.P.V. ) NEED
2 SECOND TO BE COMPLETED
THUS, WITHIN 1 MINUTE, TOTAL 120 EVENTS
SHOULD BE COMPLETED.
40. CONT…..
E.T. INTUBATION :-
ENDOTRACHIAL INTUBATION IS
INDICATED WHEN –
1. PROLONGED VENTILATION IS
NEEDED
2. B.M.V IS INEFFECTIVE
3. TRACHEAL SUCTION IS NEEDED
4. DIAPHRAGMATIC HERNIA IS
SUSPECTED
42. CONT…..
MEDICATION :-
UMBILICAL VEIN SHOULD BE USED
FOR ADMINISTERING MEDICATION.
NO INTRACARDIAC DRUG SHOULD BE
GIVEN.
SOME OF THE MEDICATIONS CAN BE
GIVEN THROUGH E.T. TUBE.
47. NURSES
RESPONSIBILITIES
BEFORE C.P.R. –
1. KEEP ALL THE EQUIPMENTS READY BY THE
TIME OF DELIVERY
2. ASSESS THE NEWBORN. CHECK H.R., TEMP,
APGAR SCORE 2 TIMES.
3. WIPE THE BABY DRY AND PLACE ON A
RADIANT WARMER
4. CHECK THE AIRWAY
5. DO SUCTIONING IF NEEDED
6. PROVIDE TACTILE STIMULATION
7. CHECK THE H.R. AGAIN
48. CONT…..
DURING C.P.R. –
1. KEEP THE AMBUBAG READY
2. COVER THE MOUTH WITH THE MASK
PROPERLY
3. MONITOR H.R. CONTINUOUSLY
4. START CHEST COMPRESSION IF H.R.
BELOW 60 beats / min
5. DO NOT GIVE EXTRA PRESSURE WHILE
CHEST COMPRESSION
6. MONITOR VITAL SIGNS CONTINUOUSLY,
SPECIALLY THE H.R.
49. CONT…..
AFTER C.P.R. –
1. MONITOR THE TEMP. OF THE BABY
2. MONITOR THE H.R.
3. PLACE THE BABY IN A RADIANT WARMER
4. DISCARD THE DISPOSABLE ARTICLES
5. SEND THE REUSABLE ARTICLES FOR
STERILIZATION
6. GIVE THE BABY TO THE MOTHER FOR
FEEDING
7. MAINTAIN ALL THE RECORD AND REPORT
IMMEDIATELY IF ANY COMPLICATION IS FOUND