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Basics of neonatal resuscitation BY DR.PRITESH PATEL
- 1. DR.PRITESH PATEL MBBS, MD(PEDIA), FIAP NEONATOLOGIST NAVSARI, GUJARAT
- 3. NEONATAL RESUSCITATION? Series of actions, used to assist newborn babies who have difficulty with making the physiological ‘transition’ from the intrauterine to extrauterine life
- 4. Most newborns are vigorous at birth. Approximately 10% will require some assistance at birth to begin breathing. Less than 1% will require extensive resuscitation.
- 6. RESUSCITATION EQUIPMENTS General: Resuscitation bed, over head warmer (servo-controlled infrared heater), towel, stethoscope, pulse oximeter Airway Management: Suction device with Suction catheter ; Bulb syringe, laryngoscope with blades (size 00 and 0); ETT (size 2.5, 3.0, 3.5); EtCO2 detector; LMA (size 1)
- 7. EQUIPMENT REQUIRED Suction Catheter Oral mucus sucker Radiant warmer
- 8. Breathing support: Facemask; PPV device, O2 gas, feeding tube, Circulation support: UVC kit, iv kit, io needle, Drug and fluids: Adrenaline(1;10000/0.1mg/ml), NS, Blood
- 13. POSITION “ SNIFFING DOG ”
- 14. CLEAR AIRWAY Suction mouth first, then nose “M” before “N” To prevent aspiration of mouth contents
- 15. DRY ,POSITION, STIMULATE Stimulate : Flicking the soles/ drying & rubbing the back
- 17. MASK Appropriate Sizes Mask should Rest on Chin Cover Mouth & Nose
- 18. Suction & Position Cup the chin in the mask and then cover the nose Light Pressure on mask to create a seal Anterior pressure on posterior rim of mandible
- 19. FREQUENCY OF VENTILATION: 40 to 60 breaths per minute Start With 21% ( higher in preterm's) oxygen and increase according to target Saturation Initial Pressure at 20mmH2O
- 20. MASK FLOW INFLATING BAG T-PIECE RESUSCITATOR
- 21. VENTILATION CORRECTIVE STEPS Corrective steps Action M Mask Adjustment Ensure Good seal of mask on face R Reposition airway Sniffing Position S Suction Mouth and nose If secretions present O Open mouth Ventilate with baby mouth slightly open and lift the jaw forward P Pressure increase Gradually increase the pressure every few breaths A Airway alternative Consider ET or Laryngeal mask airway
- 24. GUIDELINES FOR WITHHOLDING & DISCONTINUING RESUSCITATION It is based on the physician's experience and desires of the parents. In making the decision, the physician must consider the probability of neurologic damage and chances of a productive, useful life are poor, consideration should be given to discontinuing all resuscitative efforts.
- 25. It may be considered reasonable, when there have been conditions with poor outcome (i.e. gestation, birth weight, or congenital anomalies are associated with almost certain early death or unacceptably high morbidity is likely among the rare survivors) and opportunity for parental agreement, (eg <23 wk gestation; BW<400g; trisomy 13)
- 26. Discontinuing Resuscitative Efforts In a newly born baby with no detectable HR, resuscitation are discontinued if the HR remains undetectable for 10 min. Resuscitation efforts beyond 10 min with no HR should be considered if presumed etiology of the arrest, gestation of the baby, and the parental desire.
- 27. SUMMARY Doing the simple things better is probably the most cost-effective policy. Resuscitation can come as complete surprise So be prepared for resuscitation. It may take several hours to learn but it should be implemented over seconds. Practice makes one perfect.
- 28. LETS GIVE OUR NEWBORN A GOOD START! Thanks……..