neonatal resuscitation and nursing management

Neonatal resuscitation, also known as newborn resuscitation, is an emergency procedure that helps newborns who aren't breathing right away. It's designed to support about 10% of newborns who are at risk of death or irreversible organ damage if they don't start breathing.

1. NEONATAL RESUSCITATION Sakshi Srivastava Associate professor KINPMS

2. INTRODUCTION APPROXIMATELY 10% OF TOTAL NEWBORNS REQUIRE SOME ASSISTANCE TO BEGIN BREATHING AT BIRTH. LESS THAN 1% REQUIRE EXTENSIVE RESUSCITATIVE MEASUREMENTS. BASIC LIFE SUPPORT ARE NEEDED FOR THE BABIES WHO ARE HAVING BIRTH ASPHYXIA.

3. DEFINITION NEONATAL RESUSCITATION IS THE SERIES OF ACTIONS, USED TO ASSIST NEW BORN BABIES, WHO HAVE DIFFICULTY WITH MAKING THE PHYSIOLOGICAL TRANSITION FROM THE INTRAUTERINE TO EXTRAUTERINE LIFE

4. GOALS

5. GOALS THE MAIN GOALS OF NEONATAL RESUSCITATION ARE – 1. 2. 3. 4. TO INITIATE NORMAL BREATHING OF THE BABY TO MAINTAIN ADEQUATE TISSUE PERFUSION TO RESTORE NORMAL CORE TEMPERATURE TO MAINTAIN ADEQUATE CARDIAC OUTPUT

6. INDICATIONS

7. INDICATIONS MAIN INDICATIONS FOR NEONATAL C.P.R. ARE – 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. PRETERM BABIES FETAL DISTRESS BIRTH ASPHYXIA HYPOXIA HYPOPERFUSION SEVERE I.U.G.R. GRASPING RESPIRATION PERSISTENT CENTRAL CYANOSIS NO CRYING BRADYCARDIA ( H.R. < 100 beats / min )

8. EQUIPMENTS

9. EQUIPMENTS THE ESSENTIAL EQUIPMENTS WHICH ARE USED FOR NEONATAL RESUSCITATION ARE – 1. SUCTION EQUIPMENTS 2. BAG AND MASK EQUIPMENTS 3. INTUBATION EQUIPMENTS 4. MEDICATIONS 5. FLUID EQUIPMENTS 6. MISCELLANEOUS

10. SUCTION EQUIPMENTS       BULB SYRINGE SUCTION CATHETER SUCTION TUBING MECONIUM ASPIRATOR SUCTION APPARATUS SYRINGE CATHETER ( 10 mL or 20 mL )

11. BULB MECONIUM SUCTION SYRINGE ASPIRATOR CATHETER

12. BAG AND MASK EQUIPMENTS  NEONATAL RESUSCTATION BAG  FACE MASK  OXYGEN WITH FLOW METER & TUBING

13. NEONATAL RESUSCITATION BAG

14. INTUBATION EQUIPMENTS  LARYNGOSCOPE WITH STRAIGHT BLADE ( OR 1 )  STYLET  EXTRA BULB AND BATTERIES  E.T. TUBE ( SIZES ARE 2.5 , 3 , 3.5 . 4 mm )

15. LARYNGOSCOPE STYLET E.T. TUBE

16. MEDICATIONS  EPINEPHRINE  SODIUM BICARBONATE  DOPAMINE  NALOXONE HYDROCHLORIDE

17. FLUID EQUIPMENTS  INTRAVENOUS CATHETER  TAPE & STERILE DRESSING MATERIAL  DEXTROSE 10% IN WATER  ISOTONIC SALINE  T - CONNECTOR

18. MISCELLANEOUS  GLOVES  LINEN  SHOULDER ROLL  RADIANT WARMER  STETHOSCOPE  ADHESIVE TAPE  SYNRINGES ( Sizes are 1, 2, 5, 10, 20, 50 mL )  GAUZE  UMBILICAL CATHETER ( 3.5 Fr, 5 Fr )  THREE WAY STOPCOCKS  WATCH

19. RADIANT 3 WAY UMBILICAL WARMER STOPCOCK CATHETER

20. TABC OF NEONATAL RESUSCITATION

21. T STANDS FOR MAINTENANCE OF TEMPERATURE A STANDS FOR ESTABLISHMENT OF AN OPEN AIRWAY B STANDS FOR INITIATION OF BREATHING C STANDS FOR MAINTENANCE OF CIRCULATION

22. MAINTENANCE OF TEMPERATURE IT CAN BE DONE BY – RECEIVING THE BABY IN A PREWARM TOWEL PROVISION OF HEAT SOURCES DRYING THE BABY REMOVING WET LINEN

23. ESTABLISHMENT OF AN OPEN AIRWAY IT CAN BE DONE BY – 1. PROPER POSITIONING THE INFANT 2. SUCTION THE MOUTH, NOSE . IN SOME CASES TRACHEA TOO 3. IF NECESSARY, INSERT AN E.T. TUBE ALSO

24. INITIATION OF BREATHING IT CAN BE DONE BY – 1. TACTILE STIMULATION 2. P.P.V. ( POSITIVE PRESSURE VENTILATION )

25. MAINTENANCE OF CIRCULATION IT CAN BE DONE BY – 1. CHEST COMPRESSION 2. MEDICATIONS

26. PROCEDURE

27. PROCEDURE  INITIAL STAGE – 1. RECEIVE THE BABY IN A PREWARMED TOWEL 2.PLACE THE BABY IN A PREHEATED WARMER 3. POSITION THE BABY ON BACK WITH THE NECK SLIGHTLY EXTENDED ( SNIFFING POSITION ) 4.NO HYPEREXTENSION & UNDEREXTENSION

28. CONT….. 5. SUCTIONING OF THE MOUTH SHOULD BE DONE FIRST, THEN NOSE TO PREVENT THE CHANCE OF ASPIRATION OF SECRETION BY MOUTH 6. USE MECONIUM SUCCAR IN CASE OF MECONIUM ASPIRATION

29. CONT …..  PROVIDING TACTILE STIMULATION – 1. SLAPPING AND FLICKING METHOD – a) BY SLAPPING AND FLICKING THE BABY ’S SOLE OF FEET b) RUBBING INFANT ’S BACK

30. CONT ….. 2. USING FREE FLOW OXYGEN – BY BLOWING OVER THE NEONATE ’S NOSE, SO THAT THE BABY BREATHES OXYGEN ENRICHED AIR. FLOW SHOULD BE 5L / Min IF THE BABY IS HAVING SPONTANEOUS RESPIRATION, H.R. IS ABOVE 100 BEATS PER MINUTE WITH SKIN COLOR PINK, THEN BABY NEEDS ONLY OBSERVATION AND MONITORING.

31. CONT ….. NOTE : - IF THE BABY IS HAVING SPONTANEOUS RESPIRATION , H.R. IS ABOVE 100 BEATS PER MINUTE WITH SKIN COLOR PINK , THEN BABY NEEDS ONLY OBSERVATION AND MONITORING

32. CONT …..  BAG & MASK VENTILATION – SHOULD BE STARTED IF AFTER TACTILE STIMULATION – 1. THE INFANT IS STILL APNEIC OR GRASPING 2. HAVING SPONTANEOUS RESPIRATION BUT H.R. IS BELOW 100 BEATS PER MIN

33. CONT ….. FOR B.M.V. –    BABY ’S NECK SHOULD BE SLIGHTLY EXTENDED TO ENSURE OPEN AIRWAY MASK TO BE PLACED IN POSITION WHICH SHOULD COVER TIP OF THE CHIN, MOUTH AND NOSE VENTILATION SHOULD BE DONE AT THE RATE OF 40 - 60 BR. PER MIN

34. CONT …..  FOLLOW A ‘SQUEEZE ’ – ‘TWO ’ – ‘THREE ’ – ‘SQUEEZE ’ SEQUENCE.

35. CONT ….. FINDINGS INTERVENTIONS 1. 2. 3. H.R > 100 BEATS/MIN H.R. IS BETWEEN 60 – 100 BEATS/MIN H.R. < 60 BEATS/MIN 1. 2. 3. STOP B.M.V. AND MONITOR THE BABY ONLY CONTINUE B.M.V. CONTINUE WITH CHEST COMPRESSION

36. CONT …..  CHEST COMPRESSION – MUST BE PERFORMED ALONG WITH VENTILATION AND 100% OXYGENATION METHODS : - IT CAN BE DONE BY TWO METHODS, 1. THUMB COMPRESSION 2. TWO FINGER TECHNIQUE

37. CONT ….. LOCATION :- THE PRESSURE SHOULD BE APPLIED AT THE LOWER THIRD OF THE STERNUM DEPTH :- THE DEPTH SHOULD BE ½ TO ¾ INCH. RATE :- THE RATE OF CHEST COMPRESSION WILL BE 90 COMPRESSIONS AT A MINUTE ALONG WITH 30 P.P.V. TOTAL 120 EVENTS PER MINUTE

38. CONT ….. PATTERN :- TWO PERSON SHOULD BE THERE THREE COMPRESSIONS FOLLOWED BY ONE VENTILATION TIME DURATION :- 3 CHEST COMPRESSIONS SHOULD BE DONE WITHIN 1.5 SECOND 1 VENTILATION SHOULD BE DONE WITHIN 0.5 SECOND

39. CONT ….. 4 EVENTS ( 3 COMPRESSIONS + 1 P.P.V. ) NEED 2 SECOND TO BE COMPLETED THUS, WITHIN 1 MINUTE , TOTAL 120 EVENTS SHOULD BE COMPLETED.

40. CONT …..  E.T. INTUBATION :- ENDOTRACHIAL INTUBATION IS INDICATED WHEN – 1. PROLONGED VENTILATION IS NEEDED 2. B.M.V IS INEFFECTIVE 3. TRACHEAL SUCTION IS NEEDED 4. DIAPHRAGMATIC HERNIA IS SUSPECTED

41. CONT ….. TUBE SIZE SHOULD BE APPROPRIATE BLADE SIZE SHOULD BE OR 1

42. CONT …..  MEDICATION :- UMBILICAL VEIN SHOULD BE USED FOR ADMINISTERING MEDICATION. NO INTRACARDIAC DRUG SHOULD BE GIVEN. SOME OF THE MEDICATIONS CAN BE GIVEN THROUGH E.T. TUBE .

43. CONT ….. EPINEPHRINE – DOSE - 0.01 TO 0.03 mg/Kg ROUTE - I.V. SODIUM BICARBONATE – 1:1 ( WITH WATER )

44. COMPLICATIONS

45. COMPLICATIONS  PULMONARY HYPERTENSION  HYPOTHERMIA  RIBS FRACTURE  HYPOXEMIA  PNEUMOTHORAX  HYPOGLYCEMIA  TACHYAPNEA  HYPERVENTILATION  HYPOXIC ISCHEMIC ENCEPHALOPATHY

46. N URSES RESPONSIBILITIES

47. NURSES RESPONSIBILITIES  BEFORE C.P.R. – 1. KEEP ALL THE EQUIPMENTS READY BY THE TIME OF DELIVERY 2. ASSESS THE NEWBORN. CHECK H.R ., TEMP, APGAR SCORE 2 TIMES. 3. WIPE THE BABY DRY AND PLACE ON A RADIANT WARMER 4. CHECK THE AIRWAY 5. DO SUCTIONING IF NEEDED 6. PROVIDE TACTILE STIMULATION 7. CHECK THE H.R. AGAIN

48. CONT …..  DURING C.P.R. – 1. KEEP THE AMBUBAG READY 2. COVER THE MOUTH WITH THE MASK PROPERLY 3. MONITOR H.R. CONTINUOUSLY 4. START CHEST COMPRESSION IF H.R. BELOW 60 beats / min 5. DO NOT GIVE EXTRA PRESSURE WHILE CHEST COMPRESSION 6. MONITOR VITAL SIGNS CONTINUOUSLY, SPECIALLY THE H.R.

49. CONT …..  AFTER C.P.R. – 1. MONITOR THE TEMP. OF THE BABY 2. MONITOR THE H.R. 3. PLACE THE BABY IN A RADIANT WARMER 4. DISCARD THE DISPOSABLE ARTICLES 5. SEND THE REUSABLE ARTICLES FOR STERILIZATION 6. GIVE THE BABY TO THE MOTHER FOR FEEDING 7. MAINTAIN ALL THE RECORD AND REPORT IMMEDIATELY IF ANY COMPLICATION IS FOUND

50. REFERENCES  DUTTA PARUL, PEDIATRIC NURSING, JAYPEE PUBLICATION, FOURTH EDITION, PAGE NO : 75, 76,77  THOMAS SR. LISSY JMJ, CLINICAL NURSING PEDIATRIC PROCEDURE MANNUAL, PEE VEE PUBLICATION, SECOND EDITION  SHARMA R, ESSENTIALS OF PEDIATRIC NURSING, JAYPEE PUBLICATION, FIRST EDITION