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Neonatal resuscitation.pptx for health professional
- 1. Mekelle University, CHS Anesthesia Department New born resuscitation By; Hagos G. 1
- 3. Newborn resuscitation normal transition after birth • R to L blood flow in atria stops ▫ Foramen ovale closes • Flow from pulmonary artery into aorta stops ▫ Ductus arteriosus closes 3
- 4. Newborn Resuscitation normal transition after birth • Systemic arterial blood pressure rises ▫ loss of low pressure shunting through placenta • Pulmonary arterial blood pressure drops ▫ Lung expansion and oxygen cause pulmonary vessel to dilate 4
- 5. Newborn resuscitation normal transition after birth • Prevented or reversed by ▫ Hypoxia / hypercarbia ▫ Hypovolemia ▫ Sepsis ▫ Cold 5
- 6. What is neonatal resuscitation? • Newborn resuscitation is a series of actions which are used to assist newborn babies who have difficulty with making the physiological ‘transition’ between the womb and ‘the outside world’. • Newborn resuscitation assists babies who fail to initiate or sustain regular breathing at birth. 6
- 7. Newborn resuscitation equipment • Ability to dry and warm infant (25-26 C) • Shoulder roll • Ability to give positive pressure ventilation(PPV) • Oxygen • Airway equipment ▫ Straight blades #1 , #0 ▫ ETT’s 2.5, 3.0 + stylet ▫ LMA #1 + 5ml syringe ▫ Oral airway • Suction + catheters (6F, 8F) • Clock + stethoscope • Epinephrine 1:10,000 (0.1mg/ml) • Pulse oximeter very useful • PERSON DEDICATED TO CARE OF THE BABY 7
- 8. Newborn resuscitation questions for OB • Gestational age? • Amniotic fluid clear? • Number of babies? • Any other problems? 8
- 9. Newborn resuscitation Ask at birth? • Term baby? • Breathing / crying? • Good muscle tone? • Yes to all = routine care ▫ Dry baby ▫ Wipe nose and mouth if needed ▫ Skin to skin with mother ▫ Observe 9
- 10. Newborn resuscitation Ask at birth? • Term baby? • Breathing / crying? • Good muscle tone? • No to any = put baby under warmer and assess 10
- 11. Newborn resuscitation suctioning • Suction baby ONLY if ▫ Airway obstruction is present ▫ PPV is needed • Routine suctioning of babies can cause ▫ Apnea ▫ Bradycardia • DO NOT USE SUCTIONING TO STIMULATE A BABY TO BREATH 11
- 12. Newborn resuscitation meconium • No suctioning for vigorous baby • Suctioning for depressed baby only ▫ Suction before stimulation ▫ Adjustable suction attached to an ETT 0.5 mm smaller than predicted ▫ Do not delay PPV if heart rate is falling During laryngoscopy may decide to intubate with a clean normal size tube 12
- 14. Newborn resuscitation assessment under warmer • Dry and stimulate baby • Check respirations and HR (not color) • By 60 sec after birth suction and start PPV (40-60 breaths/min) for ▫ Apnea or gasping or HR < 100 ▫ Use Low O2 saturation 14
- 15. Newborn resuscitation pulse oximetry • Target saturations ▫ 1 min 60-65% ▫ 2 min 65-70% ▫ 3 min 70-75% ▫ 4 min 75-80% ▫ 5 min 80-85% ▫ 10 min 85-95% 15
- 16. Newborn resuscitation PPV • Start with AIR with term babies • Best to use a PPV device with a pressure gauge ▫ 30 cm H20 (term) and 25 cm H20 (premature) • Be sure you are ventilating ▫ Rising heart rate ▫ Chest rise ▫ Breath sounds ▫ Rising O2 saturation 16
- 17. Newborn resuscitation ventilation correction steps • M - mask adjustment • R - reposition baby, shoulder roll ▫ Attempt 5-10 breaths • S - suction • O - open mouth ▫ Attempt 5-10 breaths • P - pressure of ventilation ▫ increase slowly to max of 40 cm H2O • A - airway ▫ LMA #1 ▫ ETT 17
- 18. Newborn Resuscitation Algorithm. Kattwinkel J et al. Pediatrics 2010;126:e1400-e1413 18
- 19. Newborn chest compressions: 90 compressions/min + 30 breaths /min 3:1 ratio DO NOT Start Chest compressions unless baby has received 30 sec of Effective ventilation and HR < 60
- 20. Newborn resuscitation CPR • Use 100% O2 with chest compressions • Coordinate ventilation and chest compressions • Intubation recommended after 30 sec of chest compressions • Reassess baby after 45-60 sec of CPR 20
- 21. Newborn resuscitation epinephrine • Used if heart rate is < 60 after ▫ 30 sec of PPV and ▫ 45-60 sec of PPV and chest compressions • Epinephrine 1:10,000 solution (0.1mg/ml) ▫ 0.1-0.3 ml/kg IV ▫ 0.5-1.0 ml/kg ETT ▫ 1.0 ml saline flush • Continue CPR • Reassess after 60 sec • May repeat dose q 5 min 21
- 22. Newborn resuscitation • Volume resuscitation ▫ 10 ml/kg IV given over 5-10 min Normal saline Ringers lactate O neg whole blood Suction when secretion and when we want we want to apply PPV when we compresse Recoil_ about cardiac refill depth Rate don't interupt 22
Editor's Notes
- Newborn Resuscitation Algorithm.