1) The document outlines key principles for newborn care at birth, including preparation, drying, assessment, classification, cleaning airways if needed, skin-to-skin contact, cord clamping, early breastfeeding, observation, and examination.
2) Procedures like drying, assessing heart rate and breathing, skin-to-skin contact, delayed cord clamping for 1 minute, and early breastfeeding should be performed immediately after birth.
3) Newborns are assessed using the APGAR score at 1 and 5 minutes after birth to evaluate breathing, heart rate, color, tone and reflexes to determine if resuscitation is needed.
Hypothermia occurs when the newborn’s temperature drops below 36.3°C.
The smaller or more premature the newborn is, the greater the risk of heat loss. When heat loss exceeds the newborn’s ability to produce heat, its body temperature drops below the normal range and the newborn becomes hypothermic.
Early prevention measures are vital.
baby born before 37 weeks of gestation calculating from the first day of last menstural period is defined as preterm baby/ premature baby.
These babies are known as preemies
Hypothermia occurs when the newborn’s temperature drops below 36.3°C.
The smaller or more premature the newborn is, the greater the risk of heat loss. When heat loss exceeds the newborn’s ability to produce heat, its body temperature drops below the normal range and the newborn becomes hypothermic.
Early prevention measures are vital.
baby born before 37 weeks of gestation calculating from the first day of last menstural period is defined as preterm baby/ premature baby.
These babies are known as preemies
Defines Exchange Transfusion, the Aims, and indications of Exchange Transfusion. Articles required, choice of donor, the procedure of exchange transfusion. Post transfusion care and the complications that can occur due to exchange transfusion. The Ppt also describes the special considerations during the procedure.
Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
Defines Exchange Transfusion, the Aims, and indications of Exchange Transfusion. Articles required, choice of donor, the procedure of exchange transfusion. Post transfusion care and the complications that can occur due to exchange transfusion. The Ppt also describes the special considerations during the procedure.
Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
it contains information about the important measurements , the vital signs, head, eyes, ears, nose , mouth and throat, neck, chest, breast and abdomen of a newborn. You'll find the normal and the abnormal findings on each category.
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: the care of infants at birth, the care of normal infants, the care of low-birth-weight infants, emergency management of infants, the management of important problems.
This slide contain detail description of basic terminologies, neonatal (head to toe examination) assessment, neonatal reflexes, minor physiological handicaps of newborn
Essential new born care is the care provided to the baby immediate after the birth of the baby which is very important to reduce the neonatal mortality rate includes
supporting breastfeeding.
providing adequate warmth.
ensuring good hygiene and cord care,
recognizing early signs of danger and providing prompt treatment and.
referral, giving extra care to small babies, and.
having skilled health workers attend mothers and babies at delivery.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. 1) PREPARATION FOR DELIVERY
2) DRYING
3) ASSESSMENT OF STATE
4) CLASSIFICATION , PRECAUTIONS
5) CLEAN THE AIRWAYS AS NEEDED
6) SKIN TO SKIN CONTACT
7) CORD CLAMPING
steps 2-7 are performed 1 minute from birth.
3. 6) EARLY START OF BREAST FEEDING
7) PROPHYLACTIC ACTIVITIES
8) OBSERVATION OF MOTHER AND
NEWBORN
9) ASSESSMENT , MEASURING,
EXMINATION OF NEWBORN
10)PERFORMING ROOMING-IN IN
DAYTIME AND AT NIGHT
4. PREPARATIONS FOR DELIVERY
ALL DELIVERY EQUIPMENT & SUPPLIES INCLUDING NEWBORN RESUSCITATION
EQUIPMENT SHOULD BE READY
(E.g.: The bag & mask of resuscitation. A baby needing help to breathe could easily die
or suffer brain damage if a bag and mask is not working properly. so make sure all
equipment is checked daily well BEFORE you need to use it)
WARM & CLEAN DELIVERY ROOM, ROOM TEM: 250C
WARM BABY CLOTHS,CAP & SOCKS
(The temperature inside the mother’s womb is 38 C, once the baby is born it is in a
much colder environment and immediately starts to lose heat)
Resuscitation equipment should always be close to where the baby is being born
and health workers must know how to use it quickly and correctly.
Equipment must be checked Daily and well before a delivery takes place.
5. DRY & ASSESS:
IMMEDIATELY DRY THE NEWBORN WITH A DRY TOWEL.
ASSESS: HEART RATE, BREATHING WHILE DRYING.(to identify who
need resuscitation)
(Not all babies cry after delivery, but it doesn’t mean that they have got asphyxia: if baby
breathes regularly with frequency of 30-60 per minute but does not cry, it means the baby is
not asphyxic. This baby stays on mother’s belly while provided regular care)
SKIN TO SKIN CONTACT:
CONTAMINATION BY MOTHER’S
MICROFLORA & TO PREVENT
HYPOTHERMIA
START OF EARLY BREAST FEEDING
6. CORD CLAMPING:
MOST OPTIMAL TIME – END OF 1st MINUTE FROM DELIVERY
IF THE NEWBORN IS IN MOTHERS ABDOMEN, THE CORD CLAMPING SHOULD BE
POSTPONED UNTIL THE PULSATION STOPS.
EARLY CORD CLAMPING IS PERMITTED ONLY IN URGENT CASES (IF RESUSCITATION
IS NEEDED)
7. DELAYED CORD CLAMPING results in a shift of blood
from the placenta to the infant. Placental transfusion
was about 80% at 1 minute and was practically
completed at 3 minutes. Placental transfusion
associated with delayed cord clamping provides
additional iron to the infant's reserves and may
reduce the frequency of IRON DEFICIENCY ANEMIA
later in infancy.
Delaying cord clamping also favors early contact
between mother and baby. In addition, it also
reduces splashing of blood, which helps protect the
birth attendant in areas where HIV infection is
common.
Delaying cord clamping by 30 to 120 seconds, rather
than early clamping, seems to be associated with less
need for transfusion and less intraventricular
haemorrhage.
8. START OF EARLY BREAST FEEDING:
SKIN TO SKIN CONTACT
BABY’S ATTATCHMENT TO BREAST WHEN HE IS READY
(Council mother how to attach her baby to the breast when
he is ready)
CHECK THE CORRECTNESS OF ATTATCHMENT & FEEDING
GIVE THE NEWBORN THE OPPURTUNITY TO SUCK FROM
BOTH BREAST S LONG AS THEY NEED
ROOMING IN MOTHR & NEWBORN AS LONG AS POSSIBLE
POSTPONE WEIGHING,WASHING etc. UPTO FIRST FEEDING
9. Put the baby next to the breast with its
mouth opposite the nipple and areola.
Let the baby attach to the breast by itself
when it is ready.
Do not let a health worker attach the baby.
When the baby is attached, check that the
attachment and positioning are correct, and
help the mother to correct anything which is
not quite right and to help support her baby
if needed.
Help the mother and baby into a comfortable position
Tell the mother, when her baby begins to show signs
of wanting to feed, to help it into a position where it
can easily reach her breast.
This can take up to 1 hour after delivery.
The baby will open its mouth and start to move its
head from side to side, it may also begin to dribble.
10. The baby should have no other foods or drinks apart from colostrum, as these reduce the
amounts of protective and growth factors the baby receives from this important first milk.
Colostrum is produced in small amounts.
It contains protective factors in a concentrated form which the newborn baby needs to
keep him healthy.
It is a natural form of immunization.
Let the baby feed for as long as it wants, with no interruption. When it finishes feeding on
one breast let it feed from the other breast.
Keep the mother and baby together for as long as it is possible after delivery.
Unless there is a good medical reason delay the initial routine birth procedures, such as
weighing until after the first feed.
This first time together is very important in helping the mother and baby to get to know
each other and to form a close loving relationship.
Maternal procedures can be done with a baby in skin-to-skin contact unless she needs
treatment requiring sedation.
11. PROPHYLACTIC ACTIVITIES:
CONJUNCTIVITIS:
1% SILVER NITRATE / 0.5% ERYTHROMYCIN OINMENT / 1% TETRACYCLINE IS USED
PREVENTION OF NEWBORN OPHTHALMIA- 1% TETRACYCLINE
1% TETRACYCLINE IS EFFECTIVE AGAINST Neisseria gonorrhea & Chlamydia trachomatis &
HAVE NO SIDE EFFECTS
For effective prevention, the ointment must be applied with in 1 hour after delivery
USE OF VITAMIN-K:
TO PREVENT BLEEDING & HEMORRHAGIC DISEASE
(A single dose (1.0 mg) of intramuscular vitamin K after birth is effective in the prevention of
classic HDN. Either intramuscular or oral (1.0 mg) vitamin K prophylaxis improves biochemical
indices of coagulation status at 1-7 days)
12. THERMAL REGULATIONS REQUIRED TO COMFORT THE NEW BORN:
A NEWBORN CANNOT REGULATE HIS TEMPERATURE AND NEED PROTECTION FROM
HYPOTHERMIA
PROTECT TH BABY FROM DRAUGHT
ROOM TEMPERATURE >25
IMMEDIATE DRYING
SKIN-SKIN CONTACT
EARLY START OF BREAST FEEDING
APPROPRIATE CLOTHING
ROOMING-IN
WARM TRANSPORTATION
RESUSCITATION IN WARM CONDITIONS
14. CONVECTION
It is heat exchange with the surrounding air.
Common problems: temperature in delivery rooms, draughts.
DURING RESUSCITATION: Fan, air conditioner, radiant heater is blocked by those performing
resuscitation(Take the baby away from an open door or window).
RADIATION
It is losing heat due to the neighboring object, even if the baby is not in
direct contact with it.
Not covering the baby’s head so that its body heat is able to pass into the
surrounding air.
Common problems: Cold walls or windows. Changing tables and cradles are incorrectly
located.Cold equipment (Put a hat onto the baby’s head)
15. EVAPORATION
It is heat loss due to evaporation of fluid from the skin.
Common problems: The skin of the babies after birth is wet. Insufficient drying. No clothes
and blankets.Not drying the baby after delivery when it is wet. (Dry the baby with a towel)
CONDUCTION
It is losing heat due to the contact with, cold or wet surfaces.
Common problems: Contact with cold, wet linen, weighting on the scale, contact with cold
changing table,leaving the baby on a cold surface, particularly metal (as seen in the previous
overhead). (Take the baby off the table top, wrap it up and indicate you have put it in a cot
temporarily)
16.
17. HYPOTHERMIA CAN LEAD TO :
REDUCTION OF OXYGEN
REDUCTION OF GLUCOSE LEVEL
REDUCTION OF SUCKING REFLEX
& THUS IT CAUSES RESPIRATORY
DISTRESS, HYPOGLYCEIA, ACIDOSIS. WHICH CAN LEAD TO
BLEEDING, INFECTIONS, BRAIN INJURY, CONVULSIONS etc.
HYPOTHERMIA OF NEWBORN:
WHEN TEMPERATURE GOES
BELOW NORMAL RANGE,
TAKE PRECAUTIONS TO
WARM THE BODY.
APPROPRIATE MEASURE
SHOULD BE TAKEN TO
PREVENT SEVERE
HYPOTHERMIA
18. INITIAL ASSESSMENT
BASED ON APGAR (ACTIVITY PULSE GRIMACE APPEARANCE RESPIRATION)
SCORE
At the end of 1 and 5 minutes; if at the end of 1 and 5 minutes the baby’s score is less than 6,
the baby needs to be re-assessed at 15 and 20 minutes until we get 7 points and more.
The APGAR SCORE is not the indication for resuscitation, as resuscitation is to be started
immediately after the birth of the baby.
19. Breathing
Check whether the baby is breathing. If so, evaluate the rate, depth and symmetry of breathing together with any
evidence of an abnormal breathing pattern such as gasping or grunting.
Heart rate
This is best assessed by listening to the apex beat with a stethoscope. Feeling the pulse in the base of the umbilical
cord is often effective but can be misleading, cord pulsation is only reliable if found to be more than 100 beats per
minute (bpm). For babies requiring resuscitation and/or continued respiratory support, a modern pulse oximeter can
give an accurate heart rate.
Colour
Colour is a poor means of judging oxygenation, which is better assessed using pulse oximetry if possible. A healthy
baby is born blue but starts to become pink within 30 s of the onset of effective breathing. Peripheral cyanosis is
common and does not, by itself, indicate hypoxemia. Persistent pallor despite ventilation may indicate significant
acidosis or rarely hypovolaemia. Although colour is a poor method of judging oxygenation, it should not be ignored: if
a baby appears blue check oxygenation with a pulse oximeter.
Tone
A very floppy baby is likely to be unconscious and will need ventilatory support.
Tactile stimulation
Drying the baby usually produces enough stimulation to induce effective breathing. Avoid more vigorous methods of
stimulation. If the baby fails to establish spontaneous and effective breaths following a brief period of
stimulation, further support will be required.
20. Classification according to initial assessment
.On the basis of the initial assessment, the baby can be placed into one of three groups:
• Vigorous breathing or crying
• Good tone
• Heart rate higher than 100 min−1
•This baby requires no intervention other than drying, wrapping in a warm towel and, where appropriate, handing to
the mother. The baby will remain warm through skin-to-skin contact with mother under a cover, and may be put to the
breast at this stage.
• Breathing inadequately or apnoeic
• Normal or reduced tone
• Heart rate less than 100 min−1
•Dry and wrap. This baby may improve with mask inflation but if this
does not increase the heart rate adequately, may also require chest
compressions.
• Breathing inadequately or apnoeic
• Floppy
• Low or undetectable heart rate
• Often pale suggesting poor perfusion
22. Airway
Place the baby on his or her back with the head in a neutral position .A 2 cm thickness of the
blanket or towel placed under the baby's shoulder may be helpful in maintaining proper head
position. In floppy babies application of jaw thrust or the use of an appropriately sized oro-
pharyngeal airway may be helpful in opening the airway.
Suction is needed only if the airway is obstructed. Obstruction may be
caused by particulate meconium but can also be caused by blood
clots, thick tenacious mucus or vernix even in deliveries where
meconium staining is not present. However, aggressive pharyngeal
suction can delay the onset of spontaneous breathing and cause
laryngeal spasm and vagal bradycardia. The presence of thick
meconium in a non-vigorous baby is the only indication
for considering immediate suction of the oropharynx. If suction is
attempted this is best done under direct vision. Connect a 12–14 FG
suction catheter, or a Yankauer sucker, to a suction source not
exceeding minus 100 mm Hg.
23. Breathing
After initial steps at birth, if breathing efforts are absent or inadequate, lung aeration
is the priority. In term babies, begin resuscitation with air. The primary measure of
adequate initial lung inflation is a prompt improvement in heart rate; assess chest wall
movement if heart rate does not improve.
For the first five inflation breaths maintain the
initial inflation pressure for 2–3 s. This will help
lung expansion. Most babies needing
resuscitation at birth will respond with a rapid
increase in heart rate within 30 s of lung
inflation. If the heart rate increases but the
baby is not breathing adequately, ventilate at a
rate of about 30 breaths min−1 allowing
approximately 1 s for each inflation, until there
is adequate spontaneous breathing.
24. Adequate passive ventilation is usually indicated by either a rapidly increasing heart rate or a
heart rate that is maintained faster than 100 min−1. If the baby does not respond in this way
the most likely cause is inadequate airway control or inadequate ventilation. Look for passive
chest movement in time with inflation efforts; if these are present then lung aeration has
been achieved. If these are absent then airway control and lung aeration has not been
confirmed. Without adequate lung aeration, chest compressions will be ineffective;
therefore, confirm lung aeration before progressing to circulatory support.
Some practitioners will ensure airway control
by tracheal intubation, but this requires
training and experience. If this skill is not
available and the heart rate is decreasing, re-
evaluate the airway position and deliver
inflation breaths while summoning a colleague
with intubation skills.
Continue ventilatory support until the baby has
established normal regular breathing.
25. Circulatory support
Circulatory support with chest compressions is effective only if the lungs have first been successfully inflated.
Give chest compressions if the heart rate is less than 60 min−1 despite adequate ventilation.
The most effective technique for providing chest compressions is to place the two thumbs side by side over
the lower third of the sternum just below an imaginary line joining the nipples, with the fingers encircling the
torso and supporting the back .(An alternative way to find the correct position of the thumbs is to identify the
xiphi-sternum and then to place the thumbs on the sternum one finger's breadth above this point.) The
sternum is compressed to a depth of approximately one-third of the anterior–posterior diameter of the chest
allowing the chest wall to return to its relaxed position between compressions.
Use a ratio of three compressions to one ventilation, aiming to achieve
approximately 120 events per minute, i.e. approximately 90
compressions and 30 ventilations.
Check the heart rate after about 30 s and every 30 s thereafter.
Discontinue chest compressions when the spontaneous heart rate is
faster than 60 min−1.
26. Drugs
Drugs are rarely indicated in resuscitation of the newly born infant. Bradycardia in the newborn infant is
usually caused by inadequate lung inflation or profound hypoxia, and establishing adequate ventilation
is the most important step to correct it. However, if the heart rate remains less than 60 min−1 despite
adequate ventilation and chest compressions, it is reasonable to consider the use of drugs. These are
best given via an umbilical venous catheter
27. Stopping resuscitation
Local and national committees will determine the indications for stopping resuscitation. If the heart rate of a newly
born baby is not detectable and remains undetectable for 10 min, it is then appropriate to consider stopping
resuscitation. The decision to continue resuscitation efforts when the heart rate has been undetectable for longer
than 10 min is often complex and may be influenced by issues such as the presumed aetiology, the gestation of the
baby, the potential reversibility of the situation, and the parents’ previous expressed feelings about acceptable risk of
morbidity.
In cases where the heart rate is less than 60 min−1 at birth and does not improve after 10 or 15 min of continuous
and apparently adequate resuscitative efforts, the choice is much less clear. In this situation there is insufficient
evidence about outcome to enable firm guidance on whether to withhold or to continue resuscitation.
Communication with the parents
It is important that the team caring for the newborn baby informs the parents of the baby's progress. At
delivery, adhere to the routine local plan and, if possible, hand the baby to the mother at the earliest opportunity. If
resuscitation is required inform the parents of the procedures undertaken and why they were required.
Decisions to discontinue resuscitation should ideally involve senior paediatric staff. Whenever possible, the decision
to attempt resuscitation of an extremely preterm baby should be taken in close consultation with the parents and
senior paediatric and obstetric staff. Where a difficulty has been foreseen, for example in the case of severe
congenital malformation, discuss the options and prognosis with the parents, midwives, obstetricians and birth
attendants before delivery. Record carefully all discussions and decisions in the mother's notes prior to delivery and in
the baby's records after birth.