Neonatal Resuscitation

1. NEONATAL
RESUSCITATION
PRESENTED BY
PHATTRAPONG TANSUPOL MD.

2. หลักการที่จะทำาให้การช่วยฟื้น
ชีวิตประสบความสำาเร็จ
1.ความพร้อมของบุคลากร
2.การฝึกฝน
3.การทำางานเป็นทีม
4.ACTION/EVALUATION/DECISION CYCLE
5.อุปกรณ์ที่เพียงพอ และพร้อม
ใช้งาน

3. ACTION/EVALUATION/DECISION CYCLE
EVALUATION
ACTION DECISION

4. ASPHYXIA – THE BASIC
1.Primary Apnea:  When asphyxiated,
the infant responds with a increased RR. 
If the episode continues, the infant
becomes apnic, followed by a drop in HR
and a slight increase in BP.The infant will
respond to stimulation and therapy with
spontaneous respirations.

5. 2. Secondary apnea: after primary
apnea,  the infant responds with a period
a gasping respirations, falling HR, and
falling BP.The infant takes a last breath
and then enters the secondary apnea
period.The infant will not respond to
stimulation and death will occur unless
resuscitation begins immediately.
*  Because after delivery of an infant it is impossible to
differentiate between primary apnea and secondary
apnea, assume the infant is in secondary apnea and begin
resuscitation immediately.

6. ASPHYXIA CHANGE

7. APGAR SCORE

8. Abnormal
presentation
Operative delivery
Premature labour
Premature rupture of
membranes
Precipitous labour
Prolonged labour
Indices of fetal
distress
(FHR abnormalities,
biophysical profile)
Age > 35 years
Maternal diabetes
Pregnancy-induced
hypertension
Chronic hypertension
Other maternal illness
(e.g. CVS, thyroid, neuro)
Previous Rh sensitization
Drug therapy
(e.g. magnesium, lithium
adrenergic-blockers)
Intrapartum FactorsAntepartum Factors
Anticipation and Recognition of the
Neonate in Distress
1.Antepartum and intrapartum history

9. Maternal narcotics
(within 4 hrs of delivery)
General anaesthesia
Meconium-stained fluid
Prolapsed cord
Placental abruption
Placenta previa
Uterine tetany
Maternal substance
abuse
No prenatal care
Previous stillbirth
Bleeding - 2nd/3rd
trimester
Hydramnios
Oligohydramnios
Multiple gestation
Post-term gestation
Small-for-dates fetus
Fetal malformations
Intrapartum FactorsAntepartum Factors
1.Antepartum and intrapartum history CONT.

10. Equipment
Equipment and medications should be checked
as a daily routine and then prior to
anticipated need. Used items should be
replenished as soon as possible after a
resuscitation.
The delivery room should be kept relatively
warm and the radiant heater should be
preheated when possible. Prewarming of
towels and blankets can also be helpful in
preventing excessive heat loss from the
neonate.

11. Equipment
SUCTION EQUIPMENT
BULB SYRINGE
SUCTION CATH NO 5 6 8 10 Fr
8 Fr FEEDING TUBE 20 ml SYRINGE
MECONIUM ASPIRATOR
BAG-MASK EQUIPMENT
FACE MASK
ORAL AIRWAY
OXYGEN

12. Equipment CONT.
INTUBATION EQUIPMENT
LARYNGOSCOPY-BLADE NO 0-1
BATTERY FOR LARYNGOSCOPE
ETT NO 2.5 3.0 3.5 4.0 mm
STYLET SCISSOR GLOVE
MISCELLANEOUS
RADIANT WARMER-STETHOSCOPE-TAPE-
SYRINGE-NEEDLE-ALCOHOL-UMBILICAL CATH

13. Initial Steps for Neonatal
Resuscitation in Delivery Room
ANTICIPATION
ASSESSMENT OF ACTION
1.PREVENT HEAT LOSS
Place the infant under an overhead
radiant heater to minimize radiant and
convective heat loss.
Dry the body and head to remove
amniotic fluid and prevent evaporative
heat loss. This will also provide gentle
stimulation to initiate or help maintain
breathing.

14. Initial Steps for Neonatal
Resuscitation in Delivery Room CONT.
2.ABCDE STEP
A-AIRWAY
POSITION
CLEAR AIRWAY-SUCTION MOUTH
THEN NOSE

15. Initial Steps for Neonatal
Resuscitation in Delivery Room CONT.
B-BREATHING ADEQUACY
1.TACTILE STIMULATION
slapping or flicking the soles of
the feet
rubbing the back gently
Do not waste time continuing tactile stimulation
if there is no response after 10 - 15 seconds.
2.FREE FLOW OXYGEN
3.PPV

16. Initial Steps for Neonatal
Resuscitation in Delivery Room CONT.
C-CARDIOVASCULAR
RESUSCITATION
D-DRUG
-DIAGNOSIS
E-ENVIRONMENT
-EXTENDED CARE

17. Resuscitation in the delivery room

18. PPV
1.INDICATION FOR PPV
APNEA OR GASPING
HR < 100 bpm
CENTRAL CYANOSIS
2.BAG-Self inflating vs. flow dependent bag
3. Rate 40-60 bpm
4. Pressure used =
a.  Initial breath after delivery = 30-40 cm
H2O
      b.  Normal delivery = 15-20 cm H2O
       c.  Diseased Lungs =20-40 cm H2O

19. PPV CONT.
5. Technique/Trouble shooting problems
of Bag mask ventilation
a. Check for a good seal
   b. Check for a patent airway
    c. Are you using enough pressure ?
6.Checking for chest movement
check mask position
head position-hyperflexion or
hyperextention
secretion obstruction
slighly open infant mount
checking for pressure

20. Chest compression
1. Indications: 
If after 15-30 seconds of positive pressure
ventilation with 100% FIO2 the heart rate is
a. below 60 bpm
b.between 60-80 bpm and not increasing
2. Technique:
a. 1 fingers breadth below nipple line, using
2 fingers
       b. 1/2 to 3/4 compression depth
       c. accompanied by ventilations, ratio is 3:1

21. METHOD

22. ENDOTRACHEAL TUBE INTUBATION
1.Indications for intubation:
a.  Prolonged bag and mask ventilation
     b.  Bag and mask is ineffective
     c. Tracheal suctioning
2.Tube size
Tube size Weight Gestational Age
(ID mm) (gm) (weeks)
2.5 <1000 <28
3.0 1000-2000 28-34
3.5 2000-3000 34-38
3.5-4.0 >3000 >38

23. ดูว่าท่อหลอดลมอยู่ในตำาแหน่งที่เหมาะสมโดย
1.ฟังปอดได้ยินเสียงเท่ากัน 2 ข้าง
2.ฟังที่กระเพาะอาหารไม่ได้ยินเสียงลม
3.ทรวงอกเคลื่อนไหวเท่ากัน 2 ข้าง

24. MEDITATION
1.Indication
HR < 80 bpm despite 100% O2 and
chest compression 30 sec
No heart rate

25. Drug
-adrenaline
-volume expander
-NaHCO3
-Dopamine
-Naloxone
hydrochloride

26. Drug dosage
Give rapidly
IV or ET preferred
0.1mg/kg
0.25ml/kg
0.1 ml/kg
1 ml
1 ml
Naloxone
0.4 mg/ml
1.0 mg/ml
Give IV over 5-10 min 10 ml/kg40 mlVolume Expanders
-NS or RL
-5% Albumin
-O-neg Blood
Give rapidly IV or ET
Repeat q 3-5 min
(ET: dilute to 1-2 ml with
NS)
0.01-0.03
mg/kg
0.1-0.3 ml/kg
1 mlEpinephrine
1:10,000
Rate/Precautions Dosage PreparationDrug

27. Drug dosage cont.
Dopamine
(6 x weight in kg = mg of
dopamine diluted to 100 ml)
Sodium Bicarbonate
(0.5 mEq/ml = 4.2% soln)
Reserved for prolonged
resuscitations only
100 ml
20 ml
10 mlx2
2 mEq/kg
(4ml/kg)
Continuous infusion by
pump
Give slowly, over at least
2 min, IV ONLY, Infant
must be ventilated

28. ทารกที่ไม่ตอบสนองควร
คิดถึง
1.inadequate ventilation: missplaced
ETT,inadequate pressure,air leak
syndrome
2.Shoke: asphyxia,hypovolumic,septic
3.Congenital anomalies: pulmonary
hypoplasia,severe cardiac disease

29. THE END
Thank you