Neonatal resuscitation

1. NEONATAL RESUSCITATION BY DR SHANZA AUROOJ

2. WHAT IS NEONATAL RESUSCITATION? Neonatal Resuscitation is intervention after a baby is born to help it breathe and to help its heart beat.

3. ABC

4. PREPARATION FOR RESUSCITATION ANTICIPATION ADEQUATE EQUIPMENT ADEQUATE PERSONNEL

5. EQUIPMENT REQUIRED RESUSCITATION TABLE STERILE LINEN SUCTION APPARATUS LARYNGOSCOPE AMBU BAG & FACE MASKS ORAL AIRWAYS OXYGEN WITH FLOW METER & TUBING ENDOTRACHEAL TUBES SCISSORS GLOVES

6. MEDICATIONS Epinephrine Naloxone hydrochloride Volume expanders Normal saline Albumin 5% Ringer lactate Sodium bicarbonate4.2% Dextrose water 10% Sterile water

7. MISCELLENOUS Radiant warmer Stethoscope Adhesive tape Syringes Butterfly needles Umbilical artery catheterization tray Umbilical catheter 3 & 5 fr Feeding tube Spirit sponges

8. RADIANT WARMER

9. AMBU BAG

10. Newborn life support Clear of meconium Breathing or crying? Good muscle tone? Color pink? Term gestation? Provide warmth Position (clear airway) Dry,stimulate,reposition Give Oxygen Evaluate respiration,heart rate & colour Routine care: Provide warmth Clear airway dry Provide positive pressure ventilation Provide positive pressure ventilation Administer chest compression Administer adrenaline Supportive care Ongoing care BIRTH YES NO Breathing HR>100 & PINK APNEA Or HR<100 VENTILATING HR>100 & PINK HR<60 HR>60 HR<60 HR>60

11. HOW TO PREVENT HEAT LOSS? Place the infant under radiant heat source Dry off the amniotic fluid

12. What is the correct position? How to clear airway? Place the newborn in a supine position with neck semi extended,use a shoulder role to keep neck extended Suction the infant’s mouth and nose A=AIRWAY

13. INITIATE BREATHING Use tactile stimulation Employ positive pressure ventilation when necessary using Bag & mask Bag & endotracheal tube Ventilation rate=40/min Ventilation pressure=15-20cm of water Continue ventilation for 15-30 minutes B=BREATHING

14. WHAT ARE THE WAYS TO MAINTAIN CIRCULATION? Chest compression=when HR<60/min Sternum should be compressed ½ inch with PPV at the ratio of 3: 1 Encircle the chest with overlapping thumbs or Place middle & index finger of one hand right angle to the chest wall over sternum Continue for 30 seconds,if HR>60 & increasing stop compressions C=CIRCULATION

15. When to use medication? When HR is not increasing despite adequate ventilation with 100% oxygen & chest compression then use drugs to stimulate heart ADRENALINE(1:10,000) : 0.1-0.3 ml/kg IV, repeated every 3-5 min Volume expanders(N/S,R/L,5% albumin): 10 ml/kg IV 5-10/min Sodium bicarbonate :prolonged cardiac arrest 1-2 meq /kg IV Naloxone hydrchloride : 0.1 mg/k IV,maternal narcotics administration within 4 hours Dopamine: continued shock,dose =5-20 mg/kg/ min,continous

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