Newborn Emergencies

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Newborn Emergencies

  1. 1. EMS Resuscitation of the Newborn Jim Morgan , D.O. FAAEM Emergency Medicine EMS Medical Director Joplin, MO
  2. 2. Epidemiology  10% of newborns will require “assistance” when they’re born  Incidence of complications increase as     Birth weight decreases Prenatal problems increase Prenatal age decreases Look for antepartum & intrapartum issues
  3. 3. Physiology  Prior to delivery, newborn lungs filled with fluid  Capillaries & arterioles of lungs are closed  Blood pumped by heart bypasses lungs thru ductus arteriosis
  4. 4. Ductus Arteriosis
  5. 5. Physiology  During delivery (or shortly after), the newborn begins using lungs     Compression of chest removes fluid Sudden inspiration causes air movement to displace fluid Resistance thru lungs decreases & blood flow preferentially bypasses ductus Ductus closes & becomes ligamentum arteriosum
  6. 6. Initial Care  Airway    Maintain at level of mother’s vagina Bulb suction Gentle stimulation  Assess initial APGAR score  Prevent heat loss      Gently dry Swaddle in warm receiving blanket Avoid air drafts Skin-to-skin with mother Cutting umbilical cord    Do not milk the cord Clamp 30 seconds after delivery Clamp ~ 4 cm from newborn
  7. 7. At Birth  Is newborn full-term?  Is newborn breathing &/or crying?  Does newborn have good muscle tone?
  8. 8. At Birth  Is meconium present?    Thin meconium Thick meconium Assess O2 saturation   60 – 70% at birth May take 5 – 10 minutes to reach > 95%  Cyanosis common esp. acrocyanosis  HR ~ 150 – 180 slowing to 130 – 140  HR < 100 abnormal – begin resuscitation
  9. 9. The Distressed Newborn
  10. 10. Inverted Pyramid of Resuscitation
  11. 11. Basic “Resuscitation”  Initial care       Drying Warming Positioning Suctioning Tactile stimulation Assessment    Respiratory effort Heart rate Color
  12. 12. Airway  Ventilation      Use neonatal BVM with pop-off valve with supplemental oxygen    HR < 100 Apnea Poor O2 saturation Persistence of central cyanosis Ventilate @ 40 – 60 bpm Ventilate @ ~ 35 – 45 cm H2O OR adequate chest rise Supplemental oxygen  100% oxygen in the field
  13. 13. Neonatal Ambu Bag
  14. 14. Airway  Consider intubation     Chest compressions Difficult to ventilate Thick meconium Inadequate response
  15. 15. Chest Compressions  Encircle chest with both hands & use thumbs  Compress lower half of sternum @ 100 per minute  Discontinue if HR increases to > 80
  16. 16. Vascular Access  MOST distressed newborns respond to initial care, ventilation, & chest compressions  If vascular access needed, can use umbilical catheter   Umbilical cord with 2 arteries & 1 vein Insert catheter into vein & secure with umbilical tape
  17. 17. Medications  Naloxone   Glucose    Do not use in newborn resuscitation No specific glucose level at birth can be agreed upon Prehospital glucose administration difficult Epinephrine  0.05 - 0.1 mg/kg  (0.3 to 1 mL/kg of a 1:10,000 solution)
  18. 18. Specific Neonatal Situations               Meconium-stained amniotic fluid Apnea Diaphragmatic hernia Bradycardia Prematurity Respiratory distress/cyanosis Hypovolemia Seizures Fever Hypothermia Hypoglycemia Vomiting Diarrhea Common birth injuries
  19. 19. Congenital heart conditions        Atrial septal defect (ASD) Ventricular septal defect (VSD) Tetralogy of Fallot Transposition of the great vessels Coarctation of the aorta Pulmonary stenosis Aortic stenosis
  20. 20. Failure to respond  Mechanical blockage   Impaired lung function     Pneumothorax Diaphragmatic hernia Pulmonary atresia Central cyanosis   Meconium Congenital heart disease Apnea   Brain injury Neuromuscular disease
  21. 21. Enroute to the call  Review how you will handle   Normal birth & newborn Newborn in distress  Warm patient compartment  Consider possibility of needing back-up personnel
  22. 22. Remember….  Most newborns will respond to minimal intervention  If meconium is present AND…    Child is vigorous, light suctioning Child is flaccid, may need ETT + suction If HR    > 100, supplemental oxygen Between 60 – 100, positive pressure ventilation < 60, chest compressions  Rarely…..epinephrine thru umbilical vein  Reassess every 30 seconds
  23. 23. Questions?

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