This document discusses neonatal resuscitation and care. It begins by defining a neonate and outlining the rapid physiological changes that must occur for an infant to transition from intrauterine to extrauterine life. It then describes the risks for neonatal difficulties at birth and outlines the priorities, equipment, and techniques for resuscitation. These include providing oxygen, ventilation, chest compressions, and medications as needed. The document concludes by discussing components of initial routine neonatal care like screening, physical assessment, prophylaxis, encouraging parent-infant interaction, and preventing heat loss.

1. Neonatal resuscitation and care
By Tadesse t
March 172008

2. neonate
• Definition
• Early
• Late

3. Neonatal resuscitation
• Transition from intrauterine life to extra
uterine life
• Before delivery the fetus depends on the
placenta for gas and nutrient
• The fetus should make rapid physiologic
changes

4. • Changes
• 1-alveolar fluid clearance
• a labor
• b initial birth
• c thoracic squeeze
• 2-Circulatory change
• a dectus arteriosus
• bdecreased pulmonary vascular pressure
• 3-Lung expansion

5. • 90% transition is smooth
• 10 % need some support
• 1% need extensive support

6. risks
• Maternal conditions
 Advanced maternal age,
maternal diabetes mellitus
 hypertension,
maternal substance abuse,
 previous history of stillbirth, fetal loss or
early neonatal death

7. • Fetal conditions
 Prematurity,
 postmaturity,
 congenital anomalies,
 multiple gestation
Antepartum complications —
 Placental anomalies (eg, placenta previa)
 oligohydramnios or polyhydramnios

8. • Delivery complications —
 Transverse lie or breech presentation
 chorioamnionitis
 foul-smelling or meconium-stained amniotic fluid
 antenatal asphyxia with abnormal fetal heart
rate pattern
 maternal administration of a narcotic within four
hours of birth,
 delivery that requires instrumentation

9. Neonatal difficulties at birth include
the following
• Lack of respiratory effort
• Blockage of the airways
• Impaired lung function
• Persistent increased pulmonary vascular
resistance ( persistent fetal circulation)
• Abnormal cardiac structure and/or function

10. • Upon delivery of the head suck the
oropharynex if there is meconium
• Delivery the shoulder
• Asses the APGAR score
• Decide whether neonate is in need of
resuscitation

11. • Apgar scores are not used to guide resuscitation
but are useful as a measure of the newborn's
overall status and response to resuscitation
• When the 5-minute Apgar score is less than 7,
additional scores should be assigned every five
minutes for up to 20 minutes
• Apgar scores are not good predictors of
outcome.

12. Preparation
• Advance
• Immediate

13. Neutral Thermal Environmental
• Overhead Warmer
• Heat Lamps
• Incubator
• Warm Towels & Blankets
• Warm Water Filled Gloves

14. Resuscitation Priorities
• Oxygen
• Indications: Dusky, Poor Tone, Breathing Spont.
• Route
• Blow By or Mask if Breathing Spontaneously

15. Resuscitation Equipment
• Organized
• Readily Accessible
• Easy to Assemble

17. Universal Precautions
• Gloves
• Goggles
• Gown

19. Universal Precautions
• Gloves
• Goggles
• Gown

21. Bag-Valve-Mask Ventilation
Indications:
• Apnea or Gasping Respiration
• Heart Rate <100 bpm
• Persistent Cyanosis Despite O2 Therapy

22. Bag-Valve-Mask Ventilation
Technique
• Neutral Position of Head
• Tight Mask Seal
• Avoid Pressure on Trachea

23. Ventilation of the Newborn
Assisted rate= 40 to 60 bpm
Signs of Adequate Ventilation:
• Bilateral Chest Expansion
• Bilateral Breath Sounds
• Adequate Heart Rate & Color

24. Indications for Intubation
• BVM Ventilation Not Effective
• Thick Meconium
• Prolonged Postive Press. Vent.

25. Chest Compression
Indications:
Despite Adequate Stimulation & Effective
Ventilation With 100% O2
• Heart Rate <60 bpm
OR
• Heart Rate 60 to 80 but not Increasing

26. Chest Compressions
• Rate: 90 per minute, Interposed by Vent.
• Compression - Ventilation Ratio: 3:1
• Stop Compressions When HR >80 bpm

27. Chest Compressions
Methods:
• Two Finger Chest Compressions
– Two Fingers are Placed Just Below the Nipple
Line
• Hands-Around-the-Chest Compressions
– Two Hands Encircling the Chest
– Two Thumbs at the Nipple Line

28. Medications
Epinephrine:
• Indications: HR <80 bpm Despite IPPV &
Chest Compressions
• Dose: 0.01 to .03 mg/kg IV, ET, IO (0.1 to
0.3 mL/kg of 1:10000
• If no Response to ET , may Increase ET
Dose to 0.1 mg/kg of 1:1000

29. Mesications
Naloxone:
• Indications:
• Respiratory Depression
• Narcotic Administration Within 4 Hours of Delivery
• Dose: 0.1mg/kg IV, ET, IO, SQ
• Caution: May Cause Acute Withdrawal
Symptoms in Infants of Chronically
Addicted Mothers

30. Common Post-Resuscitation
Airway Complications
• Displaced ET Tube
• Obstructed ET Tube
• Pneumothorax
• Equipment Failure
– Inadequate Ventilatory Support
– Gastric Distension

31. • The components of initial routine care are:
 Screening for disease
Physical assessment
Prophylaxis for serious disorders
 Encouraging early maternal-infant
interaction

32. Routine care
• Prevention of heat loss
• Eye care
• Vitamin K
• Nutrition
• immunization

33. • Protecting infants against excessive heat
loss improves their chances for survival,
reduces their bodies’ need to perform
heat-producing metabolic work, and
eliminates the problems associated with
rewarming of cold infants