The document outlines the practices and principles for caring for a newborn on mechanical ventilation, emphasizing the importance of minimizing lung injury and ensuring adequate oxygenation. Key processes include proper positioning, infection prevention, and monitoring of biochemical parameters, along with detailed guidelines for suctioning and skin care. It highlights the necessity of creating an in-utero-like environment and the management of factors that could increase the newborn's oxygen demand.

1. CARING NEWBORN ON
VENTILATOR

2. Mechanical ventilation
 Mechanical ventilation or assisted
ventilation is the medical term for using a
machine called a ventilator to fully or
partially provide artificial ventilation.
 Mechanical ventilation helps move air into
and out of the lungs, with the main goal of
helping the delivery of oxygen and removal
of carbon dioxide.

3. GOALS OF MECHANICAL VENTILATION
1. Minimize the risk of lung injury.
2. Reduce patient work of breathing.
3. Provide adequate oxygenation and
ventilation with the most minimal
intervention possible.

4. Indications
1. Respiratory distress syndrome (RDS)
2. Persistent bradycardia.
3. Failure to establish spontaneous
respiration in spite of mask.
4. Extremely premature baby

5. GENERAL PRINCIPLES
1. Achieve and maintain adequate
pulmonary gas exchange.
2. Reduce newborn work of breathing.
3. Minimize the risk of lung injury.
4. Optimize newborn comfort.
5. Appropriate oxygenation

6. Positioning
 Change position: Supine, right or left
lateral every 2 – 4 hourly
 Encourages postural drainage when
indicated
 Passive physiotherapy.
 Augment with nebulization

7. Promote Respiratory
Function
 Auscultate lungs frequently to assess
for abnormal sounds.
 Suction as needed.
 Secure ETT properly.
 Monitor ABG value and pulse
oximetry.

8. Prevention of Nosocomial
Infection
Surveillance of flora
 Routine :Weekly swabs from various sites of
NICU
 Endotracheal tube tips
 Strict aseptic procedures
 Carbolysation / disinfection of all equipments
/ items entering NICU

9. Provision of in-utero like
environment
 Gentle handling
 Reduce ambient noise levels
 Control NICU environment - Optimum
Lighting
 Thermal Comfort : Thermoneutral
environment (22-26 degree celcius)

10. Minimizing Oxygen demand
 Treat fever and pain as they increase oxygen
consumption
 Preventing hypothermia
 Excessive crying and excessive movements of
limbs increase BMR and hence oxygen
demand.
 Schedule care activities at one time
 Approach softly and gently

11. Humidification
 Inadequate humidification of the
inspired air may result in increased
volume and viscosity of secretions
and this increases risk of airway
obstruction.

12. Skin care
 Skin hygiene should be maintained
properly.
 Sponge bath with tepid water.
 Mild moisturizers can be used.

13. Eye Care
 Ventilated baby is often sedated and
increase the risk of corneal ulceration
or infection.
 Eyes should be cleaned with sterile
wet swabs from inner canthus to
outer canthus.

14. Biochemical Monitoring
 Blood investigations: LFT, RFT,
electrolytes.
 ABG analysis
 Blood culture: indicated before
changing antibiotics.

15. Suctioning
 Strictly a sterile procedure
 Suction catheter size 6, 8 and 10 fr
 Duration is short – entire procedure not
more than 10 – 20 sec
 Suction pressure- 60- 80 mm hg for
neonates and infants

16. SUCTIONING

21. Articles Required
A big tray containing:
 Sterile suction catheter (6-8 fr)
 Normal saline / sterile water
 Sterile gloves
 Face mask
 Stethoscope
A sterile tray containing:
 Sterile bowl
 Gauze pieces