Neonatal resuscitation

Swaroopa Perumalla

1. NEWBORN NEWBORN
RESUSCITATIONRESUSCITATION
A.SWAROOPA
MSC(NURSING)
PEDIATRIC
NURSING

2. PRIMARY CAUSE OF DEATH
18 %Other causes
09 %Malformation
29 %Perinatal hypoxia
17 %Infection
27 %Prematurity
DEATHSCAUSE

3. 4 MILLION NEWBORN DEATHS – WHY?
ALMOST ALL ARE DUE TO PREVENTABLE
CONDITIONS

4. 4
INTRODUCTION
Basic Life Support needed for patient whose
breathing or heart has stopped
Ventilations are given to oxygenate blood
when breathing is inadequate or has stopped
If heart has stopped, chest compressions
are given to circulate blood to vital organs
Ventilation combined with chest
compressions is called cardiopulmonary
resuscitation (CPR)
CPR is commonly given to patients in
cardiac arrest as a result of heart attack

5. 5
INDICATIONS fOR
RESUSCITATION
Antepartum factors
Intra partum factors
Post partum factors
ANTEPARTUM FACTORS:
Maternal diabetes
Maternal infections
Hydromnias
Post term gestation
Maternal drug abuse
Like respiridine, lithium, carbonate
etc.

6. PRENATAL
fACTORS

7. 7
INTRANATAL FACTORS:
Abnormal presentations.
Premature labor.
Early rupture of membranes.
Foul smelling amniotic fluid.
Precipitate labor.
Fetal bradycardia.
Cord prolapse.
Meconeum stained amniotic fluid.
Narcotic administration to mother
with in 4 hrs of delivery.

8. PERINATAL fACTORS

9. ABC’s of Resuscitation
A - establish open airway Position,
suction
B - initiate breathing by Tactile
stimulation, Oxygen
C - maintain circulation Chest
compression
D - Medications
A B C (A: Airway, B: Breathing, C: Circulation)

10. •Initial steps:
–Thermal management
–Positioning
–Suctioning
–Tactile stimulation

11. Sign 0 1 2
Heart rate Absent <100
beats/min
>100
beats/min
Respirations Absent Weak cry Strong cry
Muscle tone Limp Some flexionActive motion
Reflex No responseGrimace Active
withdrawal
Color Blue, paleBody: pink
Extremities:
blue
Completely
pink

12. 1.Anticipation.
2.Adequate preparation.
3. Initial stabilization and evaluation.
4.Timely recognition, Quick and
correct action
are critical for the success of
resuscitation

13. ·Resuscitation must be
anticipated at every birth.
·Every birth attendant should
be prepared and able to
resuscitate

14. For resuscitation:For resuscitation:
1. A self-inflating Ambu bag (newborn size)
2. Two infant masks (for normal and small
newborn),
3.A suction device (mucus extractor),
4.A radiant heater (if available), warm
towels, a blanket and
5.A clock are needed

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16. 16

17. This consists of :This consists of :
drying, (thermal management) positioning
the neonate under radiant warmer to
minimize heat loss, suctioning of mouth
and nose (Tracheal suctioning if meconium
present) and provide tactile stimulation.
This should only take approximately 20
seconds

18. (1)Open the airway(1)Open the airway
·Put the baby on its back
·Position the head so that it is
slightly extended .

19. The upper airway
(the mouth then the nose) should
be suctioned to remove fluid if
stained with blood or meconiumblood or meconium

20. If the chest is rising symmetrically
with frequency >30/minute,
no immediate action is needed
(2) If there is no cry, (2) If there is no cry,
assess breathing:assess breathing:

21. If the newborn is not breathing or
gasping
Immediately start resuscitation.
There are two techniques to provide
breathing
1.Technique for artificial respiration
2.Positive pressure ventilation.

22. 1.Technique for artificial
respiration
•CLEAR THE MOUTHOF MUCOUS.
•HYPER EXTEND THE NECK WITH
ONE HAND, CLAMP THE
NOSTRILS WITH FINGERS OR
•SEAL NOSE AND MOUTH OR
NOSE ONLY
•TAKE DEEP BREATH AND FORCE
AIR INTO LUNGS.

23. When no equipment is
available:
mouth to mouth-and-nose
breathing
should be done.

24. for ensuring adequate ventilation of the
lungs, oxygenation of vital organs, and
initiation of spontaneous breathing.
The most important aspect of The most important aspect of
newborn resuscitationnewborn resuscitation

25. Ventilation can almost always be initiated
using a bag and mask.
2 basic kinds of resuscitation bags are
available.
Self inflating bag
Flow inflating bag
(it is rarely necessary to intubate)

26. OUT LINE PROCEEDURE TO
VENTILATE
·Select the appropriate mask
Reposition the newborn
·Make sure that the neck is
slightly extended.
·Place the mask on the newborn's
face, so that it covers the chin,
mouth and nose .

27. ·
Form a seal between the mask and the
infant's face. Squeeze the bag with two
fingers only.
There should be noticeable rise and fall
of chest with each inflation .

28. 28
EVALUATE THE HEART RATE
After 30 sec , count the heart rate for 6sec and
multiply it by 10 to obtain heart rate per mt.
If the HR is >100bpm and infant has spontaneous
respirations discontinue ventilation, provide tactile
stimulations and free flow oxygen.
If HR is <100 bpm ensure ventilation with 100%
oxygen initiate chest compression.

29. 29
CHEST COMPRESSION:
When ever the HR remains < than 60bpm inspite of
positive pressure ventilation.
2 types :
I.THUMB TECHNIQUE
II.TWO FINGER TECHNIQUE
oPressure to be applied vertically.
oCannot use effectively if the baby is large or if our
hands are small.
oPosition of the baby on firm surface with neck
slightly extended.

30. 30
Location:
lower third of sternum which lies between
the xyphoid and the line drawn between
nipples.
Depth of compression:
Infant: 1/2-3/4 ‘’
Child:1-1 ½”
Compression and ventilation rates and ratios:
For adult-30 compression and 2 breaths.
For infant and child-15:2

31. CHEST COMPRESSIONS:
•Place thumbs of both hands on sternum while
fingers encircle chest
•Compress breastbone with both thumbs while
fingers support the back.
Two-Rescuer CPR: Infants

32. Rescuer 1 checks
ABCs. Rescuer 2
locates site for chest
compressions.

33. ·After effectively ventilating for about
1 minute, stop briefly but do not
remove the mask and bag and look for
spontaneous breathing
·If there is none or it is weak, continue
ventilating until spontaneous
cry/breathing begins.

34. If breathing is slow (frequency
of breathing is <30), or if there
is severe chest indrawing:
continue ventilating and ask for
arrangement for referral if
possible

35. A newborn will benefit
from transfer only if it is
properly ventilated and
kept warm during transport

36. Stop ventilation
If there is no gasping or
breathing at all after 20
minutes of ventilation:

37. ·Do not separate the mother and
the newborn.
·Leave the newborn skin-to-skin
with the mother

38. ·Encourage breast-feeding within one
hour of birth.
·The newborn that needs resuscitation
is at higher risk of developing
hypoglycemia.
·Observe suckling .
Good suckling is a sign of good
recovery.

39. 1.Stimulate the heart so that it supplies
oxygen, nutrition to the body and vital
organs.
2.Increase tissue perfusion
3.Restore acid-base balance.
4.Correct acidosis.
Drugs are seldom needed to:

40. They may be required in
newborns who do not respond
to adequate ventilation with
100% oxygen and chest
compressions.

41. Sodium bicarbonate is not
recommended in the immediate
postnatal period
if there is no documented
metabolic acidosis.

42. It should therefore not be
given routinely
to newborns who are not
breathing
If it is given administer 2meq/kg
Umbilical vein
Slowly not faster than a rate of 1meq/kg/mt.

43. Epinephrine in a dose of 0.01-0.03
mg/kg should be administered if the
heart rate remains <60 bpm after a
minimum of 30 seconds of adequate
ventilation and chest compressions.
Routes: umblical vein,
endotracheal,intravenous

44. NS &RL
10ML/KG
UMBLICAL VEIN
TO BE INFUSED OVER 5-10 MTS.

45. can serve as an alternative route for
medications/volume expansion if
umbilical or other direct venous
access is not readily available.

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