This document provides an overview of neonatal resuscitation. It defines neonatal resuscitation as interventions at birth to support breathing and circulation. It discusses the history of neonatal resuscitation and how techniques have developed over time. It also outlines the key steps and principles of resuscitation including initial assessment, positive pressure ventilation, chest compressions, and intubation. Special considerations for preterm infants are also addressed.
Presentation on NRP (Neonatal Resuscitation Program)Moninder Kaur
NRP is neonatal resuscitation program. Approximately 10% of newborns require some assistance to begin breathing at birth. Less than 1% require extensive resuscitative measures. Although the majority of newly born infants do not require intervention to make the transition from intrauterine to extra-uterine life, because of the large total number of births, a sizable number will require some degree of resuscitation.
Presentation on NRP (Neonatal Resuscitation Program)Moninder Kaur
NRP is neonatal resuscitation program. Approximately 10% of newborns require some assistance to begin breathing at birth. Less than 1% require extensive resuscitative measures. Although the majority of newly born infants do not require intervention to make the transition from intrauterine to extra-uterine life, because of the large total number of births, a sizable number will require some degree of resuscitation.
Surfactant therapy |medical administration of exogenous surfactantNEHA MALIK
Surfactant therapy is the medical administration of exogenous surfactant. Surfactants used in this manner are typically instilled directly into the trachea. When a baby comes out of the womb and the lungs are not developed yet, they require administration of surfactant in order to process oxygen and survive.
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.
Surfactant therapy |medical administration of exogenous surfactantNEHA MALIK
Surfactant therapy is the medical administration of exogenous surfactant. Surfactants used in this manner are typically instilled directly into the trachea. When a baby comes out of the womb and the lungs are not developed yet, they require administration of surfactant in order to process oxygen and survive.
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.
How to resuscitate, management in meconium aspirated baby, thin and thick meconium, ratio of ventilation and perfusion in new born, latest change in guidelines for resuscitation
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.
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
2. Outline
• Definition
• History
• Overview and Principles of resuscitation
• Initial steps of resuscitation
• Positive – pressure ventilation
• Chest compressions
• Endotracheal tube intubation and LMA insertion
• Medications
• Special considerations
• Resuscitation of preterm babies
• CPAP in delivery room
• Warm transport.
3. Definition
• Neonatal resuscitation is a set of interventions at the time of birth to
support the establishment of breathing and circulation. (AAP)
Levels.
Simple interventions – drying and stimulation, suction with bulb
syringe.
Basic resuscitation – PPV (bag and mask), deep suction.
Advanced resuscitation – chest compressions, Endotracheal
Tube(ETT), medications and fluids.
4. Historical aspects.
• For the past 45years,fetal anoxia was one of the most investigated
conditions affecting the new born.
• It was then realised that obstruction to the airway immediately
following birth should be the first concern in newborn resuscitation.
• 18th century Scottish obstetrician Blundell first used mechanical
device for tracheal intubation in living newborn.
5. • In 1920, Joseph B. DeLee introduced simple rubber catheter and glass
trap to clear upper airways and stomach.
• In 1953 Apgar score was given by Varginia Apgar. She is also the first
to catheterise Umbilical Artery in new born.
Score 0 Score 1 Score 2
Appearance Blue all over Blue only at extremity No blue colouration
Pulse No pulse <100b/m >100b/m
Grimace No response to
stimulation
Grimace or feeble cry
when stimulated
Sneezing, coughing, or
pulling away when
stimulated
Activity No movement Some movement Active movement
Respiration No breathing Weak, slow or irregular
breathing
Strong cry
6. • In 1966 national guidelines for resuscitation of adults was
recommended by National Academy of Science.
• In 2000 the consensus document on advanced life support of the new
born converted the previously published advisory statements into a
set of guidelines.
• These guideline were revised further in 2010, 2015 and latest revision
being in 2020 and published in June 2021 (8th edition of the Neonatal
Resuscitation Program) by AAP and AHA.
7. Statistics
• Globally, 2 to 10 per 1000 term newborns faced perinatal asphyxia
(inability of a newborn to initiate and sustain adequate respiration
after delivery) , and the report of WHO 2014 indicated that birth
asphyxia leads to about 4million neonatal deaths annually.
• The incidence of birth asphyxia in most developed countries accounts
for less than 1/1000 of newborn deaths contrary to developing
countries where it ranges from 4.6/1000 to 26/1000 live births.
8. • More than 25.0% of the world’s newborn deaths have occurred in
Africa, of which birth asphyxia accounts for 24.0%.
• From 20 countries in the world with the highest risk of neonatal
death, 75.0% are in Africa. (Guo A et al 2017)
• The incidence of asphyxia in East, Central and southern Africa was
22.0% by 1993. (kinoti S- asphyxia of the new born in east, central
and southern Africa)
But by 2020, prevalence of perinatal asphyxia was at 18.0% and 9.0% in
East and Central African countries respectively (Yinager Workineh et al,
prevalence of perinatal asphyxia in East and Central Africa)
9. Why learn newborn resuscitation?
• Uganda’s neonatal mortality rate (NMR) is 19 deaths per
1,000 live births with 30 deaths per 1,000 live births in rural
areas and 31 deaths per 1,000live births in urban areas.
(UNICEF facts sheet 2021)
With birth asphyxia as the leading cause.
10.
11. Overview and principles
• Approximately 90% of newborns make smooth transition from
intrauterine to extrauterine life requiring little or no assistance
• 10% of newborns need some assistance
• Only 1% require extensive resuscitation
• We must always be prepared to resuscitate, as even some of those
with no risk factors will require resuscitation.
12. Fetal transition.
Before birth
• Oxygen supply by placental membranes
• No role of lungs- fluid filled alveoli and constricted arterioles due to
low O2 on Fetal blood.
• Thus the increased pulmonary resistance leads to shunting of blood
from pulmonary artery to ductus arteriosus to aorta.
13. After birth
• Baby cries - Takes first breath - Air enters alveoli - Alveolar fluid gets
absorbed -Increased P02 relaxes pulmonary arterioles - Thus
decreased PVR ( pulmonary Vascular Resistance).
• Umbilical arteries constrict and clamp cord- closure of umbilical
arteries and umbilical vein- increased SVR (Systemic Vascular
Resistance)
• Decreased PVR and increased SVR – functional closure of ductus
arteriosus- increased blood flow into lungs – oxygenation – supply to
body through aorta.
14.
15. Signs of compromised new born
These present as a consequence of interruption in transition.
Low muscle tone
Respiratory depression (apnoea/gasping )
Tachypnea
bradycardia
Hypotension
Cyanosis
Low oxygen saturation
16. Principles
• The sequence of resuscitation in adults is C-A-B
• But in newborns it remains A-B-C as the etiology of neonatal
compromise is nearly always a breathing difficulty.
• A- position and clear
• B- stimulate breathe
• C- assess HR and oxygenation
• D-drugs
17. Preparing for birth
• Review antepartum and intrapartum risk factors.
• Must know – expected gestational age? – is the amniotic fluid clear? – number of babies
expected? – any additional rick factors?
• Personnel – at least 2.
• Equipment
Resuscitation table
Sterile linen
Suction apparatus
Laryngoscope
Ambu bag and face mask
Oral airways
Oxygen with flow meter and tubing
Endotracheal tubes
Sterile gloves
21. What to do with a vigorous term newborn
• Provide warmth – 36.5 – 37.5c
place baby under radiant warmer uncovered.
• Position the head and neck
neck in neutral position, head in sniffing position.
• Clear secretions, if needed
bulb syringe or penguin sucker.
• Dry
• Stimulate
22. Re-evaluation
• Respiration – rate 40 to 60b/m
• Heart rate – auscultation or pulsations at the base of cord is felt. 6s *
10. > 100b/m
• Oxygenation by oximeter
23. Airway
• Reposition neck and head
• Suction (suction catheter with/without laryngoscope guided).
• Laryngeal mask airway.
24. • If breathing and heart rate is over 100b/m, but baby is still cyanotic:
Acrocyanosis – bluish hue of hands and feet
Central cyanosis – bluish hue of lips, tongue and torso
Place pulse ox and provide supplemental oxygen by
-flow-inflating bag and mask
-Oxygen tubing
-t-piece resuscitator
-self inflating bag
If cyanosis persists, provide positive pressure ventilation (PPV)
25.
26.
27. • Blow by oxygen using a T piece
Mengo hospital NRP
28. Target pre-ductal SPO2after birth
Minutes Target
1 min 60% -65%
2 min 65%-70%
3min 70%-75%
4 min 75%-80%
5 min 80%-85%
10 min 85%-95%
29. POSTIVE PRESSURE VENTILATION
Indication
• Apnoea
• Gasping
• HR <100b/m
• O2 saturation below the target range despite free-flow oxygen or
CPAP.
Effective ventilation is the single most important step in CPR of
compromised infant.
30. Equipment for PPV
• Masks
Rims
-cushioned , non cushioned
Shape
-round, anatomically shaped
Size
-small, large
Notably, mask should cover the tip of the chin, mouth and nose so as to
create a seal.
31. • Devices
Flow inflating bag
T-piece resuscitator
Self-inflating bag.
Each of these have advantages and disadvantages over each other.
32. Self inflating bag Flow inflating bag T-piece Resuscitator PIP
Doesn’t require compressed
source for inflation of bag
Requires compressed source
for inflation of the bag
Requires compressed gas
source for inflating the bag
Functions even without
proper seal
Doesn’t work without proper
seal
Doesn’t work without proper
seal
PIP How hard and long the bag is
squeezed
Flow of incoming gas and
how hard and long the bag is
squeezed
Can be set exactly manually
PEEP Only if additional valve is
attached
CPAP/free flow 02 Cannot be delivered Given by adjusting flow
control valve
Can be set exactly manually
Safety features Pop off valve pressure gauge Pressure gauge Maximum pressure relief
valve pressure gauge.
33. • Peak Inspiratory Pressure (PIP)
The summation of the pressure generated by the ventilator to overcome airway
resistance and alveolar resistance to attain peak inspiratory flow and to deliver
desired tidal volume.
• Positive End Expiratory Pressure (PEEP)
Is the pressure applied by the ventilator at the end of each breath to ensure
that the alveoli are not so prone to collapse.
Reduces trauma to the alveoli, increases functional residual capacity which
improves oxygenation, lesser pressure is needed to get the same volume of air
into the lung as the alveoli are already open thus increasing compliance,
ventilation/perfusion mismatches are improved.
34. CPAP
• Its the pressure in the system at the end of spontaneous breath when
a mask is held tightly on baby’s face but the bag isn’t being squeezed.
NCPAP.
35. Starting ventilation
Before beginning positive pressure ventilation:
• Select appropriate-sized mask
• Be sure airway is clear
• Position baby’s head
• Position yourself at baby’s head or side
• Confirm equipment is attached to oxygen source.
36. Continued…
• How much oxygen
• >35weeks of gestation begin with 21%
• <35weeks begin with 21-30%
• Breaths should be given at 40 to 60 bpm
• How much pressure?
• Neopuff/neotee
• PIP at 20-25cm H20
• PEEP at 5cm H2O.
37.
38. Signs of effective ventilation
• Signs of adequate ventilation
Improved heart rate, color and muscle tone.
• Signs of improvement in the newborn
Improved heart rate, color, breathing, tone and saturation.
Thus these parameters are reassessed during PPV.
39. After starting PPV
• At 15seconds, and 30seconds from the start of PPV, the assistant
should announce loudly;
1. Change in Heart rate (increasing, decreasing or the same)
2. chest movements (is moving or not moving)
3. +/- o2 saturation.
40. First assessment (after 15 seconds)
• After 15seconds of PPV
• Announce heart is
increasing
• Continue PPV
• Second HR
assessment after
15seconds of PPV
• Announce heart
rate not increasing,
chest moving.
• Continue PPV that
moves the chest
• Second HR
assessment after
another 15secs of
PPV that moves the
chest.
• Announce HR not increasing, chest is
not moving
• Ventilation corrective steps until chest
movements with PPV.
• Intubate or laryngeal mask if necessary
• Announce when chest is moving
• Continue PPV that moves the chest
• Second HR assessment after 30seconds
of PPV that moves the chest.
Increasing Not increasing chest moving Not increasing Chest not moving.
41. Second assessment (after 30 seconds)
• After 30seconds of PPV that moves the chest
• Continue PPV 40-60
breaths/min until
spontaneous effort
• Reassess ventilation
• Ventilation
corrective steps if
necessary.
• Reassess ventilation
• Ventilation corrective steps if necessary
• Insert an alternative airway
• If no improvement 100% oxygen and
chest compressions.
At least
100bpm
60-99bpm <60bpm
42. Causes and solutions for inadequate chest
expansions.
Condition Actions
Inadequate seal Reapply mask to face and lift jaw forward
Blocked airway Reposition the head
Check for secretions : suction if present.
Ventilate with the newborn’s mouth slightly open.
Not enough pressure Increase pressure until there is a perceptible chest
movement.
Consider endotracheal intubation.
43. Mr. SOPA
CORRECTIVE STEPS Actions
M Mask adjustment Reapply the mask, consider the 2 hand technique
R Reposition airway Place head neutral or slightly extended
Try PPV and reassess chest movements
S Suction mouth and nose Use a bulb syringe or suction catheter.
O Open mouth Open the mouth and lift the jaw forward.
Try PPV and reassess chest movements
P Pressure increase Increase pressure in 5 to 10cm H2O increments, maximum 40cm
H2O.
Try PPV and reassess chest movements
A Alternative airway Place an endotracheal tube or laryngeal mask.
Try PPV and assess chest movements and breath sounds
44. Orogastric tube
• After several minutes of PPV or CPAP with a mask, gas enters the
stomach and may interfere with ventilation or cause regurgitation and
aspiration.
• Place orogastric tube, suction gastric contents and leave it uncapped
to act as a vent to the stomach.
45. Chest compressions.
• Indicated when heart rate remains less than 60bpm despite
30seconds of effective PPV.
• Need 2 people.
• Ratio of 3:1 compression to ventilation ratio. (30breaths and
90compressions in one minute)
• Place thumbs or fingers 2cm below the imaginary nipple line.
• Apply pressure on the sternum during compressions, compressions
depth is approximately one-third of the anterior posterior diameter of
the chest.
• Allow chest recoil and ventilation.
49. Reassessment.
Check HR after 60seconds.
If >60bpm, stop compressions but continue ventilation at 40 to
60bpm
If <60 check quality of ventilation and compressions
If still remains less than 60bpm, consider intubation if not already
done, consider epinephrine either via ETT or insert umbilical
catheter.
51. Endotracheal intubation
Indications
To improve ventilation after several minutes ineffective bag-and-mask
ventilation
To facilitate coordination of chest compressions and ventilation
To administer epinephrine while establishing IV access.
Special
Extreme prematurity
Surfactant administration
Suspected diaphragmatic hernia.
HR <100b/m in spite of PPV.
HR <60b/m
Baby is floppy, not crying and preterm.
52. Equipment.
• Laryngoscope blade
• 00 for extreme prematures
• 0 for preterm newborns
• 1 for term newborns
• Laryngoscope, check blade, handle and functioning light.
• Suction source, set at 80-100mm Hg, large suction catheter for
mouth/pharynx, small catheter for endotracheal tube (5 or 6 F).
• Endotracheal tube size
Weight (g) Gestational Age (wks) Endotracheal Tube Size (mm
ID)
Below 1,000 Below 28 2.5
1,000n- 2,000 28-34 3.0
Greater than 2,000 Greater than 34 3.5
53. Depth of insertion.
Add 6 to the baby’s weight, tip to lip.
Weight Depth of insertion
<750g 6cm
1kg 7cm
2kg 8cm
3kg 9cm
4kg 10cm
54.
55. Steps for intubation
1. Preparation for insertion
stabilize the newborn’s head in the sniffing position.
deliver free-flow oxygen during the procedure.
2. Insertion of laryngoscope
slide the laryngoscope over right side of the tongue, pushing the
tongue to the left side of the mouth.
advance blade until the tip lies just beyond the base of the tongue.
3. Lift blade
lift the blade slightly on angle to ceiling, raising the entire blade not
just the tip.
Visualize pharyngeal area. Don’t rock.
56. 4. Visualize landmarks
Vocal cords should appear as vertical stripes on each side of the
glottis or as an inverted letter V.
apply downward pressure on cricoid to help bring glottis into
view. Suction for visualization, if necessary.
5. Inserting tube
insert the tube following the curvature of the blade. Insert the
tip of the endotracheal tube until the level of the vocal cords.
Limit attempts to 30 seconds, and if the cords are closed, wait for them
to open.
57.
58.
59.
60. Confirmation of ETT placement.
• Detecting exhaled CO2 and rapid rise in heart rate are primary
methods.
• Auscultate breath sounds during PPV, near both axillae.
• Symmetrical chest movements.
• Little or no air leak from mouth during PPV.
• Decreased or absent air entry over the stomach
• Chest X-ray.
63. If baby’s condition worsen after intubation
The DOPE mnemonic
D Displaced endotracheal tube
O Obstructed endotracheal tube
P Pneumothorax, collapsed lung
E Equipment failure.
64. CPAP in the delivery room
• Importance
• CPAP if initiated early at the time of delivery, established adequate
lung volume or functional residual capacity
• It avoids the need for intubation
• Reduces need for surfactant.
• Ventilation also leads to volutrauma and lung inflammation.
• It also prevents the injuries caused by mechanical ventilation which is
more aggressive.
65. Indications for CPAP.
Preterm neonates Term neonates
Respiratory distress in the delivery room Moderate to severe respiratory distress
Atelectasis Meconium aspiration syndrome
Recurrent apnoea Large patent ductus arteriosus
Pulmonary edema Neonatal pneumonia
66.
67.
68. Who needs CPAP immediately after birth.
Silverman Anderson Score (SAS)
• Mild 1 to 3 – supplemental O2
• moderate respiratory distress 4 to 6 – CPAP
• Severe respiratory stress 7 to 10 – intubation
Also babies weighing less than 1500grams.
Score Upper chest
retractions
Lower chest
retractions
Xiphoid
retraction
Nasal flaring Grunting
0 None None None None None
1 Lag on
inspiration
Just visible Just visible Just visible Only with
stethoscope
2 See-saw Marked Marked Marked Audible to
naked ear.
69. DRUGS.
Epinephrine
• Indicated when heart rate remains <60b/m.
• Not indicated before adequate ventilation is established
• IV or endotracheal route,
• 0.1 to 0.3ml/kg of 1:10,000 solution (0.3 to 1 ml/kg if given
endotracheal)
• As rapidly as possible.
• Reassess after 1 minute, if HR <60bpm repeat dose every 3 – 5
minutes. And consider increasing dose to higher end of range.
70. Volume expanders
• If no response to epinephrine especially with persistent bradycardia
and shock is suspected like in placenta Previa/abruption.
Normal saline is recommended but ringer’s lactate, or O Rh negative
blood can be used.
10ml/kg via umbilical vein given over 5 to 10minutes.
71. Resuscitation of preterms
• Thermoregulation:
Increase delivery room temperature
Radiant warmer
Polyethylene plastic bag or wrap
Preheated transport incubator
Monitor baby’s temperature frequently.
• Respiratory support
Use oxygen blender, adjust oxygen concentration to target 85% - 95%.
Use lower PIP 20-25cm of H20 during PPV
Consider giving CPAP and/0r surfactant.
72. Post resuscitation care.
• Monitor the baby’s temperature
• Monitor blood glucose
• Monitor the baby for apnoea and bradycardia.
• Proper transport for admission including warm transport and
maintained respiratory support.
Discontinuation of resuscitation efforts may be appropriate after 10
minutes of absent heart rate following complete and adequate
resuscitation efforts.
73. Warm transport
• The incidence of hypothermia at time of admission to the NICU in VLBW
newborns ranges from 31% to 78% (Watkinson Met al 20006 and
zymankiewicz M et al 2003)
• A study in Nsambya Hospital reported 87% of all preterms had
hypothermia at the time f admission to newborn unit (Cheptoris and
Nakibuuka et al 2016).
• each 1c decrease in axillary temperature is associated with a 28-75%
increase in neonatal mortality (abbot and Mullany LC et al 2010)
Newborns loss heat through radiation, convection, evaporation and
conduction.
79. Thank you.
Psalms 127: 1-2
Unless the Lord builds the house, its builders labour in vain.
Unless the LORD watches over the city, the watchmen stand guard in vain.
In vain you rise early and stay up late, toiling for food to eat – for he grants sleep to
those he loves.
Editor's Notes
ACOG and AAP, asphyxiated neonate – umbilical cord pH <7, Apgar score 0-3 at 5 mins, neonatal neurological manifestations (seizures, coma, hypotonia), multisystem organ dysfunction.
Epinephrine increases systemic vascular resistance,
increases coronary artery perfusion pressure and
improves blood flow to myocardium and restores depleted ATP.