This document outlines the guidelines for neonatal resuscitation, including indications for resuscitation, necessary equipment, general measures like providing warmth and clearing the airway, and specific interventions like bag and mask ventilation, chest compressions, and endotracheal intubation. It describes the prerequisites, resuscitation place, equipment, general measures to maintain warmth, position the baby, clear the airway, and stimulate. It provides details on procedures for bag and mask ventilation, chest compressions, and intubation. Documentation of interventions and guidelines for certain conditions like meconium staining and congenital diaphragmatic hernia are also summarized.

1. SHARON TREESA ANTONY
FIRST YEAR M.SC NURRSING
GOVT. COLLEGE OF NURSING
KOTTAYAM

2. INDICATIONS
 Preterm delivery
 Delivery other than normal
 Malpresentations
 Multiple pregnancy
 Fetal distress
 Meconium staining
 Severe IUGR
 Antepartum haemorrhage
 Antenatal diagnosis of fetal abnormalities

3. PREREQUISITES

4. RESUSCITATION PLACE
 FLAT SURFACE
 Warm and clean
 Room temperature 26 degree celsius
 Radiant warmer/heater/a 200 watt bulb
 Keep heat source on before delivery
 2 pre warmed towels to receive the baby

5. EQUIPMENT
 Dee Lee Trap
 Mechanical suction
 Suction catheters (12 F and 14 F)
 Feeding tubes (6 F & 8 F) and 20 ml syringe
 Neonatal self inflating resuscitation bags( 500 ml)
 Face masks ( term and preterm size)
 Oxygen with flow meter and tubing

6.  Intubation equipment
 Laryngoscope with straight blade( No.0 preterm, No.1
term)
Extra bulbs and batteries
 Endotra cheal tubes (2.5, 3.0, 3.5)
• Resuscitation drugs and fluids
Inj epinephrine
Inj naloxone
Normal saline
Sterile water

7. GENERAL MEASURES

8. WARMTH
 AVOID HYPOTHERMIA
 Delivery in a warm and draft free area
 Baby received with a pre warmed towel
 Rapidly dry head and skin
 Discard wet linen
 Wrap in a pre warmed towel
 Place on firm surface under radiant warmer/ on mother’s
body

9. POSITIONING
 Supine with head in a neutral or slightly extended
position
 May keep towel under the shoulder

10. CLEAR THE AIRWAY
 By gentle suction SOS
 First the mouth then the nose
 Only for 2-3 sec
 Suction pressure < 100 mmHg
 Avoid deep suction

11. STIMULATION
 Flicking the toes and soles twice
 Rubbing the back
COMPLETE ALL THESE STEPS IN
30 SECONDS. IF BABY IS NOT
BREATHING GO FOR BMV

12. EVALUATION
 REASSESS every 30 sec
 Consider intubation if needed
 Evaluate RR, HR, colour
 HR by auscultation
 Count for 6 sec, then *10

13. PROVIDE OXYGEN
 If normal breathing and heart rate but blue limbs
 Free flow O2 at 5L/min
 By an O2 mask/ tubing
 Monitor SPO2

14. BAG AND MASK VENTILATION
 INDICATIONS
 Apnoea or gasping respiration
 Heart rate <100 bpm
 Persistent central cyanosis despite 100% O2

15.  PROCEDURE
 Apply the mask covering the chin upto the nose
 Resuscitator at the head end or side
 Rate : 40- 60 /min
 If along with chest compression, 30/ min
 Evaluate every 30 sec until HR >100 bpm
 If HR < 60 bpm : start chest compression
 If stomach distended, decompress it

16. Causes of non expansion of chest
 Blocked airways
 Leak in mouth seal
 Insufficient inflation

17. CHEST COMPRESSION
 TECHNIQUES
 Two thumb
 Two finger

18.  RATE : 90/ MIN
 COMPRESSION :VENTILATION RATIO : 3:1
 Evaluate HR after 30 sec
 Discontinue if HR > 60 bpm

19. ENDOTRACHEAL INTUBATION
 INDICATIONS
 Meconium stained baby
 Meconium aspiration
 No response to BMV
 Congenital Diaphragmatic Hernia
 When chest compression is done simultaneously
 For administration of drugs

20. ALGORITHM

22. DOCUMENTATION
 APGAR score
 Description of interventions with time

23. When to discontinue
 No HR for >10 min
When to with held
• Gestational age < 23 weeks
• Birth weight <400g
• Trisomy 13 or 18

24. MECONIUM STAINED LIQUOR
 BABY ACTIVELY CRYING
 ONLY suctioning of mouth and nose
 BABY DEPRESSED ON DELIVERY
 Avoid initial stimulation
 BMV is contraindicated
 Endo tracheal intubation and suctionif Hr falls during
suction, give PPV

25. CONGENITAL DIAPHRAGMATIC
HERNIA
 BMV contraindicated
 If medically stable go for surgery

26. THANK YOU