the first few minutes of life is the most important and vital period to understand and also identify the survivability of a newborn. Resuscitation is one of the emergency management technique when the neonate is unable to initiate respiration on their own.
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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.
Neonatal resuscitation also known as newborn resuscitation is an emergency procedure focused on supporting the approximately 10% of newborn children who do not readily begin breathing, putting them at risk of irreversible organ injury and death.
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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.
Neonatal resuscitation also known as newborn resuscitation is an emergency procedure focused on supporting the approximately 10% of newborn children who do not readily begin breathing, putting them at risk of irreversible organ injury and death.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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2. INTRODUCTION
– The successful transition from intrauterine to extrauterine life is
dependent upon significant physiologic changes that occur at
birth.
– Although most newborns successfully make this transition at
delivery without requiring any special assistance, a small but
significant number will require additional support, including
resuscitation in the delivery room.
– 10% of all babies require resuscitation; 1% need extensive
resuscitative measures.
– Globally, about one quarter of all neonatal deaths are caused by
birth asphyxia.
– By appropriate resuscitation: Outcome of thousands of
newborns may improve.
7. What normally happens
after birth?
– Three major changes occur
– THE FLUID IN THE ALVEOLI IS ABSORBED.
– THE UMBILICIAL ARTERIES AND VEIN CONSTRICT AND ARE
CLAMPED
– Removes the low resistance placental circulation
– Increases the systemic vascular resistance.
– BLOOD VESSELS IN THE LUNG TISSUE RELAX
– Decrease resistance to blood flow
8.
9.
10.
11. WHAT CAN GO WRONG
DURING TRANSITION?
– BREATHS NOT FORCEFUL TO REMOVE ALVEOLAR FLUID
OR FOREIGN MATERIAL BLOCKS AIR ENTRY OXYGEN NOT
AVAILABLE.
– EXCESSIVE BLOOD LOSS/ POOR CARDIAC CONTRACTILITY
SYSTEMIC HYPOTENSION.
– HYPOXIA CONSTRICTION OF PULMONARY ARTERIOLES,
TISSUE OXYGEN DEPRIVATION (PPHN).
12. RESPONSE OF THE BABY TO AN
INTERRUPTION IN NORMAL
TRANSITION
– POOR MUSCLE TONE DUE TO INSUFFICIENT OXYGEN SUPPLY TO BRAIN,
MUSCLES AND OTHER ORGANS.
– DEPRESSION IN RESPIRATORY DRIVE FROM INSUFFICIENT OXYGEN SUPPLY
TO THE BRAIN.
– BRADYCARDIA
– Insufficient delivery of oxygen to heart, muscle and brain.
– LOW BLOOD PRESSURE
– POOR MYOCARDIAL CONTRACTILITY OR BLOOD LOSS
– TACHYPNEA FROM FAILURE TO ABSORB LUNG FLUID
– CYANOSIS FROM INSUFFICIENT OXYGEN IN BLOOD
17. GOALS OF RESUSCITATION
– TO ASSIST ADAPTATION TO EXTRA-UTERINE LIFE.
– TO HELP IN INFLATING LUNGS, ESTABLISHING
OXYGENATION AND VENTILATION.
– TO ESTABLISH ADEQUATE PULMONARY BLOOD FLOW.
– TO SUPPORT CARDIOVASCULAR FUNCTION.
18. SEQUENTIAL STEPS IN
RESUSCITATION:
– •Maintain body temperature (dry infant and put under radiant
warmer).
– •Clear airway and initiate ventilation.
– •Cardiac compressions, if needed.
– •Attach ECG leads, pulse oximeter and CO2 monitor and insert OG
tube.
– •Catheterize umbilical artery/vein and measure blood pressures.
– •Give resuscitation drugs as needed.
– •Assign Apgar scores at 1 and 5 min and q5 min until score is ≥7.
19. KEY PRINCIPLES OF
RESUSCITATION:
– ANTICIPATE
AT EVERY DELIVERY- ATLEAST 1 PERSON WHOSE PRIMARY RESPONSIBILITY IS
THE NEWBORN.
EITHER THAT PERSON OR SOMEONE READILY AVAILABLE- SKILLS TO
PERFORM A COMPLETE RESUSCITATION.
IF NEED FOR RESUSCITATION IS ANTICIPATED- ADDITIONAL SKILLED
PERSONNEL AND NECESSARY EQUIPMENT.
21. PREREQUISITES:
– PHYSICAL SETUP FOR RESUSCITATION
– FLAT SURFACE TO MAINTAIN POSITION OF NEONATE DURING
PROCEDURE
– WARM AND CLEAN ENVIRONMENT
– STERILE EQUIPMENTS WITH DISPOSABLE MATERIALS
– ROOM TEMPERATURE OF 26 c
– FUNCTIONAL RADIANT WARMER WITH OVERHEAD LIGHT
– PRE-WARMED TOWELS
22. EQUIPMENTS
– DEE LEE TRAP
– MECHANICAL SUCTION
– SUCTION CATHETER (12 F AND 14 F)
– FEEDING TUBES (6F AND 8F)
– NEONATAL SELF INFLATING RESUSCITATION BAGS (500 ML)
– FACE MASKS (TERM AND PRETERM)
– OXYGEN WITH FLOW METER AND TUBING
23. – INTUBATION EQUIPMENTS:
– LARYNGOSCOPE WITH STRAIGHT BLADES (No.1 for term, No. 0
for preterm)
– Extra bulbs and batteries
– Endo tracheal tubes (2.5, 3.0, 3.5)
– RESUSCITATION DRUGS AND FLUIDS:
– INJ. EPINEPHRINE
– INJ. NALOXONE
– NORMAL SALINE
– STERILE WATER
25. INITIAL STEPS
AT BIRTH
AT 30 SEC
AT 60 SEC
TERM GESTATION?
BREATHING OR
CRYING?
GOOD TONE
YES ROUTINE CARE:
PROVIDE WARMTH
CLEAR AIRWAY
DRY
ONGOING EVALUATION
WARM , CLEAR AIRWAY IF
NECESSARY, DRY, STIMULATE
26. WARMTH
– AVOID HYPOTHERMIA
– DELIVERY TO BE DONE IN A WARM AND
DRAFT FREE AREA
– BABY TO BE RECEIVED IN A PRE-WARMED
TOWEL
– RAPIDLY DRY HEAD AND SKIN OF BABY
AFTER BIRTH
– DISCARD WET TOWEL AND USE ANOTHER
PRE-WARMED TOWEL TO WRAP THE
NEONATE.
– PLACE IN RADIANT WARMER OR WITH
MOTHER SKIN TO SKIN.
27. POSITIONING
– SUPINE WITH HEAD IN NEUTRAL OR SLIGHTLY EXTENDED POSITION
WITH ROLLED TOWEL UNDER THE SHOULDER BLADES OF THE NEONATE.
28. CLEAR THE AIRWAY
– GENTLE SUCTION SOS
– FIRST MOUTH THEN NOSE TO PREVENT ASPIRATION OF THE
MUCUS AND MECONIUM.
– EACH SUCTION IS ONLY FOR 2-3 SEC.
– SUCTION PRESSURE IS TO BE MAINTAINED AT < 100 mmHg
– AVOID DEEP SUCTIONING
29.
30. STIMULATION
– FLICKING THE SOLE AND TOES TWICE
– RUBBING OF BACK
COMPLETE ALL THIS IN 30 SECS IF
NOT RESPONSIVE GO FOR BMV
31. EVALUATION
– REASSESS EVERY 30 SEC.
– CONSIDER INTUBATION, IF NEEDED
– EVALUATE HR,RR, COLOUR
– HR BY AUSCULTATION
– COUNT FOR 6 SEC THEN 10 SEC.
32. HR BELOW 100,
GASPING? APNEA
YES
LABOURED
BREATHING?
PERSISTENT CYANOSIS
ROUTINE CARE
30
Sec
60
Sec
PPV, SPO2 MONITORING
HR BELOW 100?
CLEAR AIRWAY, SPO2
MONITORING CONSIDER
CPAP
YES
POST-RESUSCITATION
CARE
YES
TAKE VENTILATION
CORRECTIVE STEPS
HR BELOW 60
TAKE VENTILATION
CORRECTIVE STEPS
Intubate if chest does not
rise
CONSIDER
HYPOVOLEMIA
PNEUMOTHORAXYES
NO NO
NO
33. PROVIDE OXYGEN
– IF NORMAL BREATHING, HEART RATE BUT BLUE
LIMBS
– FREE FLOW OXYGEN AT 5L/MIN
– BY AN OXYGEN MASK/TUBING
– MONITOR SPO STATUS.
34.
35. BAG AND MASK
VENTILATION
– INDICATIONS:
– APNEA OR GASPING
– HR <100 BEATS/MIN
– PERSISTENT CENTRAL CYANOSIS DESPITE 100% OXYGEN
36. PROCEDURE
– APPLY THE MASK OVER THE CHIN
AND NOSE
– RESUSCITATOR SHOULD STAND AT
THE HEAD END
– RATE 40-60/MIN
– IF CHEST COMPRESSIONS IS DONE
THEN 30/MIN
– EVALAUTE EVERY 30 SEC UNTIL
HR>100 BPM
– IF HR IS<60 BPM START CHEST
COMPRESSIONS.
– IF STOMACH IS DISTENDED,
DEFLATE IT.
37. –CAUSES OF NON-INFLATION OF CHEST:
– BLOCKED AIRWAYS
– LEAK IN MOUTH SEAL
– INSUFFICIENT INFLATION OF BAG
38. YES
CONSIDER INTUBATION
CHEST COMPRESSIONS
COORDINATE WITH PPV
HR BELOW 60?
IV EPINEPHRINE
TARGET PREDUCTAL SPO2
1 MIN 60-65%
2 MIN 65-705
3 MIN 70-75%
4 MIN 75-80%
5 MINS 80-85%
10 MINS 85-90%
0.01=0.03 mg/kg
1:1000 (0.1 mg/ml)
42. – RATE : 90/ MIN
– COMPRESSION : VENTILATION = 3:1
– EVALUATE HR AFTER 3O SEC
– DISCONTINUE IF HR <60 BPM
43. INDICATIONS FOR
ENDOTRACHEAL INTUBATION
– MECONIUM STAINED BABY
– MAS
– NO RESPONSE TO BMV
– CONGENITAL DIAPHRAGMATIC HERNIA
– WHEN CHEST COMPRESSION IS DONE SIMULTANEOUSLY
– FOR ADMINISTRATION OF DRUGS
44. WHEN TO DISCONTINUE
– NORMAL HR FOR >10 MINS.
– WHEN TO RESTRICT OR WITHHELD?
– GA < 23 WEEKS
– BIRTH WEIGHT < 400 GMS
– TRISOMY 13 OR 18
– MECONIUM STAINED LIQUOR
– CONGENITAL DIAPHRAGMATIC HERNIA
45.
46. DOCUMENTATION
– ASSESS AND RECORD THE APGAR SCORE.
– DESCRIPTION OF EVENTS AND TREATMENT PROTOCOLS WITH
TIME TO BE RECORDED.