This document provides recommendations from the 2015 Neonatal Resuscitation Guidelines on various topics relating to neonatal resuscitation. It discusses recommendations regarding umbilical cord management, maintaining normal temperature, warming hypothermic newborns, administration of oxygen, positive pressure ventilation, and other aspects of resuscitation. The recommendations are based on levels of evidence and aim to optimize resuscitation practices for improved newborn outcomes.
About 10% of all newborn require some assistance to begin breathing after birth, and 1% require extensive resuscitation efforts. Newborn resuscitation cannot always be anticipated in time to transfer the mother before delivery to a facility with specialized neonatal support. Therefore, every hospital with a delivery suite should have an organized, skilled resuscitation team and appropriate equipments available.
This is only providing the theoretical aspects of neonatal resuscitation and will be helpful for the student nurses to understand what exactly the neonatal resuscitation and compare it with practical scenario.
step by step description of resuscitation in newborn for clinical year 2 medical students easier to understand and help revise for exam and osce examinations
Drowning Prevention: A Contemporary Health Issue That Impacts EveryoneAudrey Dalton
Drowning prevention is something we all need to know more about. When you are in near or on the water you should be aware of the dangers that water represents and how you can stay safe and keep your family and friends safe. Learn to swim. Teach your children to swim early. Wear USCG approved life jackets. Follow the Safer Three: Safer Water, Safer Kids, Safer Response. Respect the awesome power of water.
About 10% of all newborn require some assistance to begin breathing after birth, and 1% require extensive resuscitation efforts. Newborn resuscitation cannot always be anticipated in time to transfer the mother before delivery to a facility with specialized neonatal support. Therefore, every hospital with a delivery suite should have an organized, skilled resuscitation team and appropriate equipments available.
This is only providing the theoretical aspects of neonatal resuscitation and will be helpful for the student nurses to understand what exactly the neonatal resuscitation and compare it with practical scenario.
step by step description of resuscitation in newborn for clinical year 2 medical students easier to understand and help revise for exam and osce examinations
Drowning Prevention: A Contemporary Health Issue That Impacts EveryoneAudrey Dalton
Drowning prevention is something we all need to know more about. When you are in near or on the water you should be aware of the dangers that water represents and how you can stay safe and keep your family and friends safe. Learn to swim. Teach your children to swim early. Wear USCG approved life jackets. Follow the Safer Three: Safer Water, Safer Kids, Safer Response. Respect the awesome power of water.
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.
Hello guys, bringing to you the concept of golden hour of neonatology. As in trauma, the first hour of neonatal life is most precious and this ppt is an attempt to highlight a few key aspects of this resuscitative strategy in premature infants.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
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.
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.
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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
3. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Umbilical Cord
Management
for longer than 30 seconds is
reasonable for both term and
preterm infants who do not require
resuscitation at birth
Class IIa
LOE C-LD
There is insufficient evidence to
recommend an approach to cord
clamping for infants who require
resuscitation at birth
we suggest against the routine use of
cord milking for infants born at less
than 29 weeks of gestation
Class IIb,
LOE C-LD
4. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Importance of
Maintaining
Normal
Temperature
in the Delivery
Room
Hypothermia is also associated with
serious morbidities, such as
increased respiratory issues,
hypoglycemia, and late-onset sepsis.
Temperature should be recorded as a
predictor of outcomes as well as a
quality indicator
Class I,
LOE B-NR
temperature of newly born
nonasphyxiated infants be
maintained between 36.5°C and
37.5°C after birth through admission
and stabilization
Class I,
LOE C-LD
5. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Interventions
to Maintain
Newborn
Temperature
in the Delivery
Room
The use of radiant warmers and
plastic wrap with a cap has improved
but not eliminated the risk of
hypothermia in preterms in the
delivery room.
Class IIb,
LOE B-R,
B-NR, C-LD
warmed humidified gases and
increased room temperature plus
cap plus thermal mattress were all
effective in reducing hypothermia.
For all the studies, hyperthermia was
a concern, but harm was not shown.
Hyperthermia (greater than 38.0°C)
should be avoided due to the
potential associated risks
Class III:
Harm, LOE
C-EO
6. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Warming
Hypothermic
Newborns to
Restore
Normal
Temperature
The traditional recommendation for
the method of rewarming neonates
who are hypothermic after
resuscitation has been that slower is
preferable to faster rewarming to
avoid complications such as apnea
and arrhythmias. However, there is
insufficient current evidence to
recommend a preference for either
rapid (0.5°C/h or greater) or slow
rewarming (less than 0.5°C/h) of
unintentionally hypothermic
newborns (temperature less than
36°C) at hospital admission. Either
approach to rewarming may be
reasonable (Class IIb, LOE C-LD).
7. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Maintaining
Normothermia
in Resource-
Limited
Settings
In resource-limited settings, to
maintain body temperature or
prevent hypothermia during
transition (birth until 1 to 2 hours of
life) in well newborn infants, it may
be reasonable to put them in a clean
food-grade plastic bag up to the level
of the neck and swaddle them after
drying (Class IIb, LOE C-LD)
Another option that may be
reasonable is to nurse such
newborns with skin-to-skin contact
or kangaroo mother care (Class IIb,
LOE C-LD).
8. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Clearing the
Airway When
Meconium Is
Present
However, if the infant born through
meconium-stained amniotic fluid
presents with poor muscle tone and
inadequate breathing efforts, the
initial steps of resuscitation should
be completed under the radiant
warmer. PPV should be initiated if
the infant is not breathing or the
heart rate is less than 100/min after
the initial steps are completed.
Routine intubation for tracheal
suction in this setting is not
suggested, because there is
insufficient evidence to continue
recommending this practice (Class
IIb, LOE C-LD).
9. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Assessment of
Heart Rate
During resuscitation of
term and preterm
newborns, the use of 3-
lead ECG for the rapid and
accurate measurement of
the newborn’s heart rate
may be reasonable (Class
IIb, LOE C-LD).
10. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Administration
of Oxygen in
Preterm
Infants
In all studies, irrespective of whether
air or high oxygen (including 100%)
was used to initiate resuscitation,
most infants were in approximately
30% oxygen by the time of
stabilization. Resuscitation of
preterm newborns of less than 35
weeks of gestation should be
initiated with low oxygen (21% to
30%), and the oxygen concentration
should be titrated to achieve
preductal oxygen saturation
approximating the interquartile
range measured in healthy term
infants after vaginal birth at sea level
(Class I, LOE B-R).
11. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Positive
Pressure
Ventilation
(PPV)
There is insufficient data regarding
short and long-term safety and the
most appropriate duration and
pressure of inflation to support
routine application of sustained
inflation of greater than 5 seconds’
duration to the transitioning
newborn (Class IIb, LOE B-R).
In 2015, the Neonatal Resuscitation
ILCOR and Guidelines Task Forces
repeated their 2010
recommendation that, when PPV is
administered to preterm newborns,
approximately 5 cm H2 O PEEP is
suggested (Class IIb, LOE B-R).
12. 2015 guideline update
recommendation
Topic Recommendation LOE comments
PPV can be delivered effectively with
a flow-inflating bag, self-inflating
bag, or T-piece resuscitator (Class IIa,
LOE B-R).
Use of respiratory mechanics
monitors have been reported to
prevent excessive pressures and tidal
volumes and exhaled CO2 monitors
may help assess that actual gas
exchange is occurring during face-
mask PPV attempts. Although use of
such devices is feasible, thus far their
effectiveness, particularly in
changing important outcomes, has
not been established (Class IIb, LOE
13. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Laryngeal masks, which fit over the
laryngeal inlet, can achieve effective
ventilation in term and preterm
newborns at 34 weeks or more of
gestation. Data are limited for their
use in preterm infants delivered at
less than 34 weeks of gestation or
who weigh less than 2000 g. A
laryngeal mask may be considered as
an alternative to tracheal intubation
if face-mask ventilation is
unsuccessful in achieving effective
ventilation (Class IIb, LOE B-R).
A laryngeal mask is recommended
during resuscitation of term and
14. 2015 guideline update
recommendation
Topic Recommendation LOE comments
CPAP Based on this evidence,
spontaneously breathing preterm
infants with respiratory distress may
be supported with CPAP initially
rather than routine intubation for
administering PPV (Class IIb, LOE B-
R).
15. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Compressions are delivered on the
lower third of the sternum to a
depth of approximately one third of
the anterior-posterior diameter of
the chest (Class IIb, LOE C-LD).
Because the 2-thumb technique
generates higher blood pressures
and coronary perfusion pressure
with less rescuer fatigue, the 2
thumb–encircling hands technique is
suggested as the preferred method
(Class IIb, LOE C-LD).
16. 2015 guideline update
recommendation
Topic Recommendation LOE comments
It is still suggested that compressions
and ventilations be coordinated to
avoid simultaneous delivery. The
chest should be allowed to re-
expand fully during relaxation, but
the rescuer’s thumbs should not
leave the chest. The Neonatal
Resuscitation ILCOR and Guidelines
Task Forces continue to support use
of a 3:1 ratio of compressions to
ventilation, with 90 compressions
and 30 breaths to achieve
approximately 120 events per
minute to maximize ventilation at an
achievable rate (Class IIa, LOE C-LD).
17. 2015 guideline update
recommendation
Topic Recommendation LOE comments
The Neonatal Guidelines Writing
Group endorses increasing the
oxygen concentration to 100%
whenever chest compressions are
provided (Class IIa, LOE C-EO).
To reduce the risks of complications
associated with hyperoxia the
supplementary oxygen concentration
should be weaned as soon as the
heart rate recovers (Class I, LOE C-
LD).
18. 2015 guideline update
recommendation
Topic Recommendation LOE comments
The current measure for
determining successful
progress in neonatal
resuscitation is to assess
the heart rate response.
Other devices, such as
end-tidal CO2 monitoring
and pulse oximetry, may
be useful techniques to
determine when return of
spontaneous circulation
19. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Evidence suggests that use of
therapeutic hypothermia in
resource-limited settings (ie, lack of
qualified staff, inadequate
equipment, etc) may be considered
and offered under clearly defined
protocols similar to those used in
published clinical trials and in
facilities with the capabilities for
multidisciplinary care and
longitudinal follow-up (Class IIb, LOE-
B-R).
20. 2015 guideline update
recommendation
Topic Recommendation LOE comments
However, in individual cases, when
counseling a family and constructing
a prognosis for survival at gestations
below 25 weeks, it is reasonable to
consider variables such as perceived
accuracy of gestational age
assignment, the presence or absence
of chorioamnionitis, and the level of
care available for location of delivery.
It is also recognized that decisions
about appropriateness of
resuscitation below 25 weeks of
gestation will be influenced by
region-specific guidelines. In making
this statement, a higher value was
placed on the lack of evidence for a
21. 2015 guideline update
recommendation
Topic Recommendation LOE comments
Until more research is available to
clarify the optimal instructor training
methodology, it is suggested that
neonatal resuscitation instructors be
trained using timely, objective,
structured, and individually targeted
verbal and/or written feedback
(Class IIb, LOE C-EO).
Studies that explored how frequently
healthcare providers or healthcare
students should train showed no
differences in patient outcomes (LOE
C-EO) but were able to show some
advantages in psychomotor
performance (LOE B-R) and