This document provides guidance on newborn resuscitation. It discusses that resuscitation helps the newborn breathe and establishes heart rate after birth. The key steps are drying the baby thoroughly, assessing color, tone, breathing and heart rate, clearing the airway if needed, giving inflation breaths with a bag and mask, and performing chest compressions if the heart rate does not increase. It emphasizes the importance of reassessment and controlling the baby's temperature during recovery. Drugs may be considered only if the baby does not respond to initial resuscitation efforts, but the prognosis is generally poor if drugs are needed.

1. BY SR.ASABA MARION
Tel:0778670084/0753931275
Email mugonzebwamarie@gmail.com

2.  Is an intervention after a baby is born to help it breath and
help heart beat
 Resuscitation is helping with airway, breathing & circulation
AKA ABCs
 INDICATIONS
 Inadequate or ineffective respiration
 Inadequate heart rate
 Central cyanosis

3. EQUIPMENTS
 Clock
 Warm dry towels
 Bag & masks
 Firm stable surface
 Gas supply and blow off valve Esp. oxygen
 Face masks and tracheal tubes
 Suction equipment's

4.  Guedel airways
 Laryngoscope
 Lighting
 Drugs
 Sodium Bicarbonate
 Adrenaline
 Dextrose
 (Volume)
 Wide bore sucker
 Scissors and tape

5.  Here is a summary of the logical approach to the baby not breathing at birth.
 All babies are small and wet at delivery and therefore all babies will require
immediate attention to prevent them getting cold. This is true even in babies
needing urgent resuscitation.
 During this time one can briefly assess whether this baby needs any further
attention.
 Emphasise drying the baby. Most babies need simple things done well.

6.  Babies are small and wet
 They get cold very quickly
 Dry the baby and then
 cover with warm dry towels

7. • Start the clock
• Dry the baby
• Assess
Do you need help??.......................
 Initial assessment
• Colour
• Tone
• Breathing
• Heart rate

8.  Blue Pink
 Good tone
 Breathing regularly
 Fast heart rate
 Dry and cover
 Give to Mum

9.  Blue
 Moderate tone
 Breathing inadequately
 Slow heart rate
 Dry and cover
 Open the airway
 Inflation breaths?

10.  Blue or pale
 Floppy
 Not breathing
 Slow or very slow heart rate
 Dry and cover
 Open the airway
 Inflation breaths
 Re-assess
 Do you need help ?

11.  In the unconscious baby airway
obstruction is usually due to
loss of pharyngeal tone
 NOT
 foreign material in the airway i.e POSITION NOT SUCTION

12. • Hold head in neutral position
• Consider jaw thrust when necessary
• Give inflation breaths

14. Here the anaesthetist has
applied a well fitting mask to
the baby’s face and is
supporting the baby’s chin
with his middle finger

15.  Inflation breaths
 Five breaths,
 each sustained for 2-3 seconds
 at 30 cm of water pressure
 A long inflation time is needed for the first few breaths to ensure inflation /
aeration of the lungs

16.  Give inflation breaths then
 Reassess
 What would you hope to find ?
 an Increase in HEART RATE
 Mask inflation is
 nearly always effective
 Only about 1 in 500
 appear to need intubation

17.  About 95% of babies for whom help is called
 will recover within a minute or two
 once air enters the lungs
 If the heart rate responds
 you can assume
 the lungs have been inflated
 Keep checking the heart rate to ensure that it remains above 100…

18.  If the heart rate does not respond to inflation breaths then:-
 Either You have NOT inflated the lungs
 Or The heart needs help to respond
 HOW CAN YOU TELL WHICH IS TRUE ?

19.  If the lungs are being inflated then the chest will move with each inflation
breath
 If the chest is not moving the lungs are not being inflated
 Check A & B

20. Resus 26
© RC (UK)

21. If you don’t have a
second person
available you may find
that a Guedel airway is
helpful.

22.  Another possibility is that the airway may be blocked with meconium or a
blood clot or some other foreign body.
 Look with a laryngoscope.
 Anything capable of blocking the airway will need a large bore sucker to
remove it.
 Suction under direct vision

23.  The heart rate has increased
 and is now above 100…
 but the baby is not breathing
 Ventilate at ~ 30 breaths per minute
 until the baby is breathing well

24.  What if
 …. the chest IS moving
 but the heart rate is still slow
 Consider chest compressions

25.  Chest compression
 You want to move oxygenated blood from the lungs to the coronary arteries
 It’s not that far and won’t take long

26.  This is a practical skill which will be taught in the skill stations.
 In the new ADULT resuscitation guidelines even more emphasis has been
put on chest compressions. This is because an adult with a cardiac arrest will
usually have lungs which already contain air. Also they are not usually
grossly acidotic at the time of collapse.
 At birth, on the other hand, babies will have lungs full of fluid and will already
be grossly acidotic if they are in serious difficulties. Massaging more
unoxygenated blood around the place will do nothing.
 The lungs MUST BE INFLATED FIRST.
 Also you are not trying to maintain brain perfusion you are just trying to
return oxygenated blood back to a healthy heart

27.  Reasses
 Has the heart rate improved ?
 No
 Check airway
 Chest movement
 Chest compression
 Most babies who actually need chest compressions will respond with an
increase in heart rate within less than half a minute.

28.  If they don’t you should go back and check that the airway really is open, that
the lungs really have been inflated and that chest compressions are really
being given effectively.
 If all of these are true and there is STILL no response then the baby is in
serious trouble.
 It might be worth considering drugs.

29. • Bicarbonate, Adrenaline, Dextrose, Atropine
 If drugs really are necessary then the prognosis is poor.
 There is a lot of anecdotal evidence of good outcome following the giving of
drugs in resuscitation but it is far from certain that the babies in question
really needed drugs.
 Many would probably have responded to ABC if it had been well applied.
 There is no firm scientific evidence supporting any particular order for the
administration of drugs..

30.  The mnemonic merely emphasises that this is a bad place to be.
 Bicarbonate, adrenaline and dextrose may all have a role.
 Only adrenaline may be given down the tracheal tube but its effectiveness
through lungs recently filled with fluid is unknown.
 Otherwise drugs require central venous access via a UVC. Peripheral access
is pointless if the circulation is at a standstill.
 Volume is often given but rarely needed

31.  REASSESSMENT
 Remember temperature control. Continually reassess the baby as he
recovers. Remember that a small or scrawny baby, or even a well grown
baby, may have used up much of its reserves during this episode and may
later be unable to maintain a normal blood sugar without some intravenous
glucose.
 Parents – explain what has happened and be prepared for questions. Don’t
try to bluff your way. If you don’t know the answer to their questions find
someone senior who does.
 Records should contain times of events wherever possible. State the facts.
Do not add your interpretations or opinions. Don’t use terms like ‘birth
asphyxia’ or ‘fetal distress’.

32.  No heart rate after 10 minutes of continuous good quality
resuscitation
 Dry & cover the baby
 Assess the situation
 Airway
 Breathing - Inflation breaths
 Chest compressions
 (Drugs)

33. Dry
&
cover

34. 
GROUP 3 (6)
 BREAST FEEDING
Group 4 (6)
 Complimentary feeding or weaning
Group 5 (6)
 feeding problems

35. Thank you for listening
Questions ????