How to resuscitate child

1. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amnlotic fluid clear?
• Breathing or crying?
• Good muscle tone?u
• Provide warmth
• Position clear airway*
(as necessary)
• Dry, stimulate, reposition
Routine Care
• Provide warmth
• Clear airway if needed
• Dry
• Assess color
Evaluate respiration heart rate and color
Give supplementary
oxygen
Observational Care
Provide positive-pressure ventilation* Post-resuscitation care
• Provide positive-pressure
ventilation*
•Administer chest compression
Administer epinephrine and/ or volume*
* Endotracheal intubation may be
considered at several steps
HR <60
HR <60 HR >60
Persistent
cyanosis Effective
Ventilation,
HR>100 & Pink
Breathing, HR>100
but cyanosis
Breathing,
HR>100 & Pink
Yes
No
Apneic or HR
<100
Approximate
Time
30 sec
30 sec
30 sec

2. Key principles
 Anticipate
 Prepare
 Universal precautions

3.  Anticipate
 Prepare
 Universal precautions

4.  Anticipate
 Prepare
 Universal precautions

5.  Anticipate
 Prepare
 Universal precautions

6.  Anticipate
 Prepare
 Universal precautions

7. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amnlotic fluid clear?
• Breathing or crying?
• Good muscle tone?u
• Provide warmth
• Position clear airway*
(as necessary)
• Dry, stimulate, reposition
Routine Care
• Provide warmth
• Clear airway if needed
• Dry
• Assess color
Evaluate respiration heart rate and color
Give supplementary
oxygen
Observational Care
Provide positive-pressure ventilation* Post-resuscitation care
• Provide positive-pressure
ventilation*
•Administer chest compression
Administer epinephrine and/ or volume*
* Endotracheal intubation may be
considered at several steps
HR <60
HR <60 HR >60
Persistent
cyanosis Effective
Ventilation,
HR>100 & Pink
Breathing, HR>100
but cyanosis
Breathing,
HR>100 & Pink
Yes
No
Apneic or HR
<100
Approximate
Time
30 sec
30 sec
30 sec

8. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amniotic fluid clear?
• Breathing or crying?
• Good muscle tone?
Approximate
Time
30 sec
30 sec
30 sec

9. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amnlotic fluid clear?
• Breathing or crying?
• Good muscle tone?
Routine Care
• Provide warmth
• Clear airway if needed
• Dry
• Assess color
Yes
Approximate
Time
30 sec
30 sec
30 sec

10. Provide warmth

11. Provide warmth

12. Routine care
 Wipe secretions
 Dry
 Assess color

13. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amnlotic fluid clear?
• Breathing or crying?
• Good muscle tone?
• Provide warmth
• Position clear airway*
(as necessary)
• Dry, stimulate, reposition
Routine Care
• Provide warmth
• Clear airway if needed
• Dry
• Assess color
Yes
No
Approximate
Time
30 sec
30 sec
30 sec

14. Provide warmth

15. Provide warmth

16. Provide warmth

17.  Avoid hypothermia
 VLBW may require special efforts
 KMC
 Polyethylene bags
 Avoid hypothermia
Provide warmth

18. Position, clear airways
(as necessary)

19. Position, clear airways
(as necessary)

20. Position, clear airways
(as necessary)

21. Dry, stimulate, reposition

22. Dry, stimulate, reposition

23. Dry, stimulate, reposition

24. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amnlotic fluid clear?
• Breathing or crying?
• Good muscle tone?
• Provide warmth
• Position clear airway*
(as necessary)
• Dry, stimulate, reposition
Routine Care
• Provide warmth
• Clear airway if needed
• Dry
• Assess color
Yes
No
Approximate
Time
30 sec
30 sec
30 sec

25. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amnlotic fluid clear?
• Breathing or crying?
• Good muscle tone?
• Provide warmth
• Position clear airway*
(as necessary)
• Dry, stimulate, reposition
Routine Care
• Provide warmth
• Clear airway if needed
• Dry
• Assess color
Yes
No
Approximate
Time
30 sec
30 sec
30 sec
Evaluate respiration heart rate and
color
Observational Care
Breathing, HR>100 &
Pink

26. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amnlotic fluid clear?
• Breathing or crying?
• Good muscle tone?
• Provide warmth
• Position clear airway*
(as necessary)
• Dry, stimulate, reposition
Routine Care
• Provide warmth
• Clear airway if needed
• Dry
• Assess color
Yes
No
Approximate
Time
30 sec
30 sec
30 sec
Evaluate respiration heart rate and
color
Observational Care
Breathing, HR>100 &
Pink
Give supplementary
oxygen
Breathing, HR>100 but
cyanosis

27. Oxygen: term babies
 Use 100%: if cyanosis or PPV required
 Less than 100%: possibly also effective
 If resuscitated with less than 100% oxygen:
administer O2 up to 100% if no appreciable
improvement within 90 sec following birth
 If supplemental O2 is unavailable: use room
air

28. Oxygen: preterms (<32 wk)
 Use blender and pulse oximeter
 Begin PPV with FiO2 0.21-1.0
 Adjust O2 to achieve SO2 of 95%
 Decrease O2 if SO2 above 95%.
 If HR <100 bpm: correct ventilation & use 100% O2
 If no facility of blender & pulse ox: manage as term
babies
 No convincing evidence that a brief period of 100%
oxygen during resuscitation will be detrimental

29. Supplemental oxygen

30. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amniotic fluid clear?
• Breathing or crying?
• Good muscle tone?
• Provide warmth
• Position clear airway*
(as necessary)
• Dry, stimulate, reposition
Routine Care
• Provide warmth
• Clear airway if needed
• Dry
• Assess color
Yes
No
Approximate
Time
30 sec
30 sec
30 sec
Evaluate respiration heart rate and
color
Observational Care
Breathing, HR>100 &
Pink
Give supplementary
oxygen
Breathing, HR>100 but
cyanosis
Provide positive-pressure ventilation*
Persistent
cyanosis
Apneic or HR
<100

31.  Term
 Liquor clear
 Crying
 Actively moving
Case - 1

32. Case 2
 Term
 Liquor clear
 Poor cry
 Limp

33.  Term woman, early labor
 Membranes ruptured and thick
meconium revealed
 Breathing
 Limp
Case - 3

34. Any difference ?
Meconium thick or thin

35. No need for intrapartum suction
Birth: assess
HR, breathing and tone
Vigorous: HR>100
good breathing
Good tone
Nonvigorous: any
parameter abnormal
Initial steps Tracheal suction

36. Tracheal suction
 Two persons
 Equipments
 ETT
 Suction
 Connections

38. Tracheal suction
 Place under radiant warmer
 Postpone drying
 Insert laryngoscope
 Suction under direct vision
 Insert tracheal tube
 Apply suction while you withdraw

40. Initial tracheal suction
Minimal meconium
Initial steps
Significant meconium
Assess HR
Significant bradycardia No significant
bradycardia
Repeat tracheal suction

41. NEONATAL FLOW ALGORITHM
BIRTH
• Term gestation?
• Amniotic fluid clear?
• Breathing or crying?
• Good muscle tone?
• Provide warmth
• Position clear airway*
(as necessary)
• Dry, stimulate, reposition
Routine Care
• Provide warmth
• Clear airway if needed
• Dry
• Assess color
Yes
No
Approximate
Time
30 sec
30 sec
30 sec
Evaluate respiration heart rate and
color
Observational Care
Breathing, HR>100 &
Pink
Give supplementary
oxygen
Breathing, HR>100 but
cyanosis
Provide positive-pressure ventilation*
Persistent
cyanosis
Apneic or HR
<100