neonatal resuscitation also known as new born resuscitation

New Natal resuscitation

1. neonatal resuscitation, also known as newborn resuscitation, is an emergency procedure focused on supporting approximately 10% of newborn children who do not reading being breathing, putting them at risk of irreversible organ injury and death. positive air way pressure and in severe cases chest compression medical personal certified in neonatal resuscitation can often stimulate neonates to being breathing on their own with attendant normalization of heart rate. Introduction

2. Definition Neonatal resuscitation is a set of intervention used to assist the airway breathing and circulation of a newborn following birth. Neonatal resuscitation is the series of action used to assist newborn babies who have difficulty with making the physiological transition from the intrauterine to extra uterine life. According to Annamma jacob Major taken to revive newborn who have difficulty in establishing respiration at birth and include & suctioning, positive pressure ventilation , external cardiac massage , intubation and medication as necessitated by the units condition at 1 minute after birth.

3. Purposes To established and maintain a clear airway. To insure effective circulation. To correct any acidosis present. To prevent hypothermia, hypoglycemia .

4. Assessment :- most new born babies are vigorous at birth. only about 10% require some resuscitative assistance. though babies who will need resuscitation at birth , can be identified by the presence of ante- partum or intra-partum risk factor…. MATERNAL RISK FACTOR mother age <16 & >32 years Inadequate antenatal care. significant ante – partum hemorrhage. (Abruptio Placenta, placenta Previa ). preeclampsia or Eclampsia. maternal hypertension maternal medical problems ( cardiac, pulmonary, renal, thyroid anaemia , etc. poly hydramnios . oligo hydramnios . FOETAL RISK FACTOR pre term / post term. previous foetal or neonatal death. intra uterine growth retardation. significant malformations or anomalies in foetus intrauterine infection. reduced foetal movements before onset of labour . INTRAPARTUM RISK FACTORE meconium stained amniotic fluid. reduced foetal movement. precipitate labour , prolonged labour breach or other non vertax presentation. cord prolapse . chorioamnionitis . narcotics administered to mother within 4 hrs of delivery. maternal general anesthesia / sedation.

5. PREPARATION OF DELIVERY ROOM 1. Close all the doors & windows and draw the curtains to ensure privacy. 2. providing warmth:- switch off the fans to avoid direct draught of air over the baby . a well – lit, room with temperature in the range of 26-28 c is ideal for delivery room. 3. switch on the radiant warmer, twenty minutes before the delivery and place two baby sheets before delivery to ensure that the baby is received in a pre- warmed sheet to maintain warm chain. use heating / cooling devices depending on local conditions. newborn care corner is the designated place to perform resuscitation. it has a set of equipment and supplies which should be ensured and checked before delivery.

6. RESPECTFUL MATERNITY CARE it include :- privacy, confidentiality, provision of birth companion, choice of birthing position , cordial, congenital and supportive environment etc. to ensure privacy have screen between the labour tables, prevent direct entry to the labor room, curtains or screens should be drawn on doors and windows. ensure that the patient is not exposed. ensure confidentiality about patient’s. all the pregnant women who are going to deliver in the facility must be treated with dignity and respect, have freedom from discrimination and receive equitable and empathetic care.

7. EQUIPMENT 1. suctioning articles:- bulb syringe . de lee’s mucus traps with no. 10 French catheter or mechanical section. suction catheter number 6,8,10. feeding tube number 8 french and 20 ml syringe. 2 bag and mask articles infant resuscitation bag with pressure release valve or pressure gauge with reservoir capable of delivery 90 -100% oxygen. face mask with cushion dreams newborn and premature size. oral airway ( new born & premature size). oxygen with flow meter and tubing.

8. 3. innovation articles:- laryngoscope with straight blade number 0 (premature number one newborn. extra balls and batteries for laryngoscope. Endotracheal tube sizes 2.5, 3.0, 3.5 mm internal diameter. a) scissors. 4. medication a) Epinephrine 1:10,000 ampule (1 ml ampule of 1:1000 available in india ). b) Naloxone hydrochloride ( neonatal norcan 0.02 mg / ml).

9. c) volume extender - 5% albumin solution - normal saline - ringer lactate d) sodium bicarbonate 4.2% (2ml) 7.5% strength approximately 0.9 meq / ml. e) dextrose 10% concentration 250 ml. f) sterile water 30 ml g) normal c9 30 ml. 5. miscellaneous radiant warmer , stethoscope, at a sweet dream and scissor, size 1 ml 2 ml 5 ml and 20 ml size, needle number 21 22 in 26 g., umbilical cord clamp gloves, warms dry towel.

10. INFECTION PREVENTION :- WHO PROMOTES SIX “CS” CLEAN HANDS CLEAN PERINEUM CLEAN DELIVERY CLEAN CORD CLEAN CORD TIE CLEAN CORD CARE STEPS OF HAND WASHING :- PALM & FINGERS AND WEB SPACES BACK OF HANDS FINGER AND KNUCKLES THUMBS FINGERTIPS WRISTS AND FOREARM UPTO ELBOW.

11. Procedure Nursing actions 1 assess the AFGAR score. 2. place infant under warmer quickly dry of amniotic fluid replace weed seat with a dry one. 3. place the baby on his back with slightly head down 15 degrees till, neck slightly extended. 4. suction the mouth first and then nose. 5. give textile stimulation if infant does not breath (flick or tap the soul or foot twice or rub the back) do not slap. 6. check the vital sign and color of the newborn Rational help to know it resuscitation measures are to be instituted. prevent heat loss. straight the trachea and open the air way. hyperextension may cause airway obstruction. clear the airway passes infant often guest when the nose is suctioned and may aspirate secretions. textile stimulation may bring spontaneous respiration. . help in determining future needs for resuscitation.

12. Evaluation Evaluation should be done on respiration heart rate and color if the baby is happening heart rate is less than 100 bpm and Central cyanosis is present proceed for bag and mask ventilation or positive pressure ventilation.

13. Bag and mask ventilation/ positive pressure ventilation bag and mask ventilation should be started it after textile stimulation. indication:- 1. apnea or gasping. heart rate less than 100 bpm . it should be done after tracheal suction in thick meconium stained liquor. contraindications:- diaphragmatic hernia..

14. Procedure Nursing action Please the newborn on his back with head slightly extended. A tight scene is to be formed over the infant mouth and nose with the face mask. Ventilate at a rate of 40- 50 breath / min. Ventilate 4:15 to 30 second and evaluate Have an assistant to evaluate listen to the heart rate for 6 second and multiply by 10 to get the actual rate per minute. Rational Help in opening airway hyperextension may cause airway obstruction. Prevent leakage of oxygen from the sides of the mask. To help maintain a rate of 40-60 bpm trying saying breath two three as one ventilate the newborn. Spontaneous respiration maybe initiated with initial attempt to ventilate. To get actual rate per minute.

15. Evaluation All thought ad is the baby is breathing adequately and has a heart rate of more than 100 bpm then gradually reduce the rate and volume of ventilatory support and watch for the baby breathing if the baby is breathing. well breathing at a rate of 40-60 with per minute regular and with no restrictions then stop positive pressure ventilation while continuing to gently stimulate the baby to take a breath provide observational care to baby who have received bag and mask ventilation for less than a minute.

16. Observational care with mother…. Points to remember during observational care Keep the mother and baby together in skin to skin contact to keep the baby warm. Never leave the mother and new one alone monitor the due every 15 minute during the first hour. Check the thing temperature and colour watch for complication and refer immediately if present. Encourage the mother to breastfeed her baby as soon as she is ready. this will help prevent hypoglycemia. Assess the babies attachment at the breast help the mother breastfeed if needed good sucking is a sign of recovery if the baby is unable to suck effectively have the mother to express colostrum . Record the sequence of event during resuscitation and explain them to the mother and family keeping record of event which occur at the time of delivery and in the immediate period afterward can be vital the information is important if a baby need to we referred or become sick in the next few days. If not breathing well :- IF heart rate is above 100 bpm and spontaneous respiration are present discontinue begging. If heart rate is 60-100 bpm and increasing continue ventilation check whether chest is moving adequately. If heart rate is below 80 b p m start chest compression. If heart rate is below 60 b p m in edition to begging and chest compression consider integration and initiate medication. Sign of improvement A) increasing heart rate. B) spontaneous respiration. C) improving skin color of the baby .

17. Continue to provide free flow oxygen by face mask after respiration are established if the baby deteriorate check the following:- 1.placement of face mask for tight seal. 2.head position and presence of secretions. 3.presence of air in the stomach. 4.presenting chest expansion oxygen being delivered (100% or not).

18. Chest compression chest compression consist of rhythmic compression of the sternum that compresses the heart against the spine increases the intra thoracic pressure and circulate blood to the vital organs just compression must always be accompanied by ventilation with 100% oxygen to assure that the circulating blood is well oxygenated. Indication heart rate list than 30 bpm after wagging with 100% oxygen for 15- 30 seconds. heart rate 68 bpm and not increasing after waking with hundred percent oxygen for 15 -30 seconds.

19. Procedure Nursing actions compress the chest by placing the hand around the newborn chest with the finger under the back to provide support and the thumb over the lower third of the sternum. or used to finger of one hand to compress the chest and place the other hand under the back to provide support. compress the sternum to a debt of approximately one third of the anteroposterior diameter of the chest and with sufficient force to cause of table pulse the finger should remain it contact with the chest between compressions use three compression followed by one ventilation for a combined rate of compression and ventilation of 120 each minute this provide 90 compression and 30 ventilation each minute pause for ½ second after every third compression for ventilation. check the heart rate after 30 second if it is 60 bpm or more this continue compression but continue ventilation until the heart rate is more than hundred bpm and spontaneous breathing bings . Rational correct hand position compresses the heart and avoid injury to the liver explain fracture of the ribs and pneumothorax. the size of the newborn determine the depth of compression to avoid injury. simultaneous compression and ventilation may interfere with adequate ventilation the short allowed here to enter the lungs. periodic evaluation is necessary to ensure that treatment is appropriate to the infant status..

20. Endotracheal intubation Endotracheal intubation is a specialized and skill procedure. Indication Heart rate below 60 bpm in spite of begging and chest compression. Presence of meconium in the amniotic fluids.

21. Procedure Nursing actions please infant with head slightly extended with a role towel under the shoulder. introduce laryngoscope over the babies tongue at the right corner of the mouth. advance 2- 3 cm while rotating it to midline until the epiglottis is seen. elevation of the epiglottis with the teeth of the laryngoscope reveal the vocal cords. suction secretion if needed. pass the endotracheal tube a distance of 1.5, 2 cm into the trachea hold if firmly but gently in place and withdraw the laryngoscope slowly. attached the endotracheal tube to the adaptor on the bag. ventilate with oxygen by bag and assistant should check for adequate ventilation of both lungs with stethoscope. Rational position make the airway open. clean the airway. ensure adequate air entry into both lungs.

22. Medication Medication should be administered if despite adequate ventilation with 100% oxygen and chest compression the heart rate remains at 80 bpm . Epinephrine :- 0.1- 0.3 ml/ kg in 1:10,000 dilution is given iv when there is persistence bradycardia intratracheal administration can also be given it may be repeated every 5 minute. Sodium bicarbonate:- to combat metabolic acidosis ( ph <7.2) iv (4ml / kg of 0.5 meq /ml 4.2% solution) is given reversible of narcotic drug is needed when mother has been given pethidine or morphine within 3 hour of delivery. Arrenge for refferal if advance care is not available .

23. When to stop ventilation Bag and mask ventilation should be continued until the baby established spontaneous breathing. however if there no sign of life is being with no breathing no heart sound and no moment and remain so even after 10 minute of birth ventilation may be stopped in if there are any sign of life during research station then the research institute effort must continue for 30 minutes before terminating the same when withdrawing or with hold this resuscitation, care should be focus on the comfort and dignity of the baby and family.

24. Recording Record the procedure in nurses record document the baby’s condition before and after procedure. Chest compression after every third chest compression Ventilation should be continued. In 1 minute 90 chest compression and 30 positive pressure ventilation should be carried out 3:1.

25. Bibliography 1 ghai , essential pediatric 9 edition published by cbs publisher and distributor pvt ltd page number 126. 2 dorothy r. marlow’s , text book of pediatric nursing south asian edition elsevier a division of need elsevier india private limited page number 233 3. parul dutta paediatric nursing second edition published by jp brother medical publisher pg number 82. 4. piyush gupta essential pediatric nursing 4 th edition published by cbse publisher and distributor pvt ltd pg number 496. wong’s , essential of paediatric nursing 10 edition elsevier , a division of read elsevier india private limited.

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