Educational

1. SARASWATI AYURVED HOSPITAL AND MEDICAL
COLLEGE, GHARUAN (MOHALI)
DEPARTMENT OF KAUMARBHRITYA
NEONATAL RESUSCITATION
Submitted to:- Presented By:-
Dr. Sobha Gupta Manisha Mittal
Dr. Anu Gupta BAMS 3RD
Prof.
Dr. Mani Kusum

2. INTRODUCTION
It is a series of actions used to assist newborn babies having difficulty
making physiological transition from intrauterine to extrauterine life.
GOALS
To initiate normal breathing of the baby.
To restore normal core temperature.
To maintain adequate cardiac output.

3. EQUIPMENTS
The essential equipments which are used for neonatal
resuscitation are:-
 Suction equipments
 Bag and Mask equipments
 Intubation equipments
 Medications
 Miscellaneous

4. SUCTION EQUIPMENTS
Bulb Syringe
Suction Catheter
Suction Tube
Meconium Aspirator
Suction Apparatus
Syringe Catheter 10,12 or 14F

5. BAG AND MASK EQUIPMENTS
Neonatal Resuscitation Bag
Face Mask (for both term and preterm babies)
Oxygen with Flow Meter and Tubing

6. INTUBATION EQUIPMENTS
Laryngoscope with straight blades no. 0(preterm)and no. 1(term)
Extra bulbs and batteries(for laryngoscope)
Endotracheal tube 2.5,3.0,3.5 and 4.0mm ID
Stylet

7. MEDICATIONS
Epinephrine
Normal saline or Ringer’s Lactate
Naloxone hydrochloride
Sterile water

8. MISCELLANEOUS
Stop watch
Linen, shoulder roll, gauze
Radiant warmer
Stethoscope
Adhesive tapes, scissors
Syringes 1,2,5,10,20,50ml
Feeding tube 6F
Umbilical catheter 3.5,5 F
Gloves
Three way stopcocks

9. APGAR SCORE
 The Apgar score is a quick test performed on newborns at 1 and 5
minutes after birth to assess their physical condition and need for
immediate medical care.
 Each factor is given a score of 0, 1, or 2, with a total possible score
ranging from 0 to 10.
 SCORE
0-3 Severe depression
4-6 Mild depression
7-10 Normal
 Vitals are checked at 1 minute and then after 5 minutes
immediately after birth. If score is still less then repeat this for 20
minutes at 5 minutes interval.

11. TABC Of Neonatal Resuscitation
T-Temperature: Provide warmth, dry the baby and remove the
wet linen.
A-Airway: Position the infant, clear the airway (wipe baby's
mouth and nose or suction mouth, nose and in some instances,
the trachea). If necessary, insert an endotracheal (ET) tube to
ensure an open airway.
B-Breathing: Tactile stimulation to initiate respirations, positive-
pressure breaths using either bag and mask or bag and ET tube
when necessary.
C-Circulation: Stimulate and maintain the circulation of blood
with chest compressions and medications as indicated.

13. PROCEDURE
INITIAL STEPS
PROVIDE WARMTH
The baby should be placed under
the radiant warmer to prevent
hypothermia in supine postion
with head in neutral position.
POSITIONING
The baby should be placed on her back or side with the neck slightly
extended.

14. CLEAR AIRWAY
 The mouth is suctioned first to ensure that there is nothing for the
infant to aspirate, if he/she should gasp when the nose is suctioned.
 Order of cleaning is mouth, oropharynx, hypopharynx and nose.
SUCTIONING METHOD
 Size of catheter should be 12 or 14 Fr.
 The catheter is inserted upto maximum of 3cm in nose and 5 cm in
mouth .
 Maximum time limit for suctioning is 15 seconds

15. DRY, STIMULATE AND REPOSITION
 After suctioning, the baby should be dried using prewarmed linen to
prevent heat loss.The wet linen should be removed away from baby.
 The act of suctioning and drying themselves provides enough
stimulation to initiate breathing.
 If the newborn continues to have poor respiratory efforts, additional
tactile stimulation in form of flicking the soles or gently rubbing the
back may be provided briefly to stimulate breathing.

16. BAG AND MASK VENTILATION

17. ENDOTRACHEAL INTUBATION
Place the baby on a flat surface in supine position with fully extended neck
Folded towel or blanket placed beneath the shoulders(operator sits at the head end)
Open the infant mouth( with the operator’s index finger and thumb of right hand)
Introduce the lighted laryngoscope into the nasopharynx upto the epiglottis(by
operator’s left hand)
The glottis is cleared by gentle suctioning
An endotracheal tube is gently inserted through the larynx

18. It is not pushed too far to prevent its entry into the Right Bronchus
The laryngoscope is withdrawn
PPV given through the endotracheal tube as long as the heart beat get
established
Give free flow oxygen through the lid of the endotracheal tube for few seconds
Withdrawn the endotracheal tube with the help of laryngoscope
Continue bag and mask ventilation for 15 seconds after extubation.

20. AMBU BAG
Ambu bag, is a handheld tool that is used to deliver positive pressure
ventilation to any subject with insufficient or ineffective breaths. It
consists of a self-inflating bag, one-way valve, mask, and an oxygen
reservoir.

21.  Ideal capacity of a bag for a neonate is 240-750 ml.
 For a baby <1500g use a bag of 240ml -350ml capacity.
PROCEDURE
Ensure the neonate airway is clear and the bag is properly assembled
Select the appropriate mask size and apply it to the face creating a tight
seal
Deliver breaths by squeezing the bag observing for chest rise and
releasing to allow exhalation
Monitor the neonate response and adjust ventilation as needed

22. CHEST COMPRESSIONS
 Chest compressions consist of rhythmic compressions of the
sternum that compress the heart against the spine, increase
intrathoracic pressure and circulate blood to the vital organs of the
body.
 Indication:- If heart rate is below 60 beats per minute.
There are two techniques of chest compressions
1) Thumb technique:- In this two thumbs are used to depress the
sternum with the hands encircling the torso and the fingers
supporting the back.
2) Two finger technique:- In this the top of middle finger and either
the index finger or ring finger of one hand are used to compress
the sternum. The other hand is used to support the infant back.

23. Compression rate:- 120 beats/min in ratio 3:1 coordinated with
ventilation with 1-2cm depth.
Site:- Lower third of the sternum
During the procedure, fingers or thumb must never be taken off
the sternum in between compressions.

24. EVALUATION
After a period of 30 seconds of chest compressions , the heart rate is
checked.
a. HR below 60: Chest compressions should continue along with bag
and mask ventilation. In addition, medications (epinephrine) have
to be administered.
b. HR 60 or above: Chest compressions should be discontinued. BMV
should be continued until the heart rate is above 100 beats per
minute and the infant is breathing spontaneously.
RISKS
Chest trauma: Fractures, Pneumothorax, Laceration of liver

25. MEDICATIONS
 Epinephrine: 0.1-0.3 mL/kg intravenous(IV) in 1: 10,000 dilution. The
same dose may be repeated every 5 minutes.
 Volume expanders: Normal saline, whole blood, 5% albumin or Ringer
lactate is indicated in acute bleeding with signs of hypovolemia.
 Sodium bicarbonate: It is indicated in documented metabolic acidosis in a
dose of 1-2 mEq/kg/minute (4.2% solution) slowly over 2 minute period
after effective ventilation.
 Dopamine: It is indicated in poor peripheral perfusion, weak pulse,
hypotension, tachycardia and decreased urine output persisting after the
initial resuscitative effort. In a dose 5-20 mg/kg/minute as a continuous
IV infusion.