Neonatal resuscitation.pptx for health professional

It about neonatal resuscitation

1. Mekelle University, CHS Anesthesia Department New born resuscitation By; Hagos G. 1

2. New born resuscitation priorities 2

3. Newborn resuscitation normal transition after birth R to L blood flow in atria stops Foramen ovale closes Flow from pulmonary artery into aorta stops Ductus arteriosus closes 3

4. Newborn Resuscitation normal transition after birth Systemic arterial blood pressure rises loss of low pressure shunting through placenta Pulmonary arterial blood pressure drops Lung expansion and oxygen cause pulmonary vessel to dilate 4

5. Newborn resuscitation normal transition after birth Prevented or reversed by Hypoxia / hypercarbia Hypovolemia Sepsis Cold 5

6. What is neonatal resuscitation? Newborn resuscitation is a series of actions which are used to assist newborn babies who have difficulty with making the physiological ‘transition’ between the womb and ‘the outside world’. Newborn resuscitation assists babies who fail to initiate or sustain regular breathing at birth. 6

7. Newborn resuscitation equipment Ability to dry and warm infant (25-26 C) Shoulder roll Ability to give positive pressure ventilation(PPV) Oxygen Airway equipment Straight blades #1 , #0 ETT’s 2.5, 3.0 + stylet LMA #1 + 5ml syringe Oral airway Suction + catheters (6F, 8F) Clock + stethoscope Epinephrine 1:10,000 (0.1mg/ml) Pulse oximeter very useful PERSON DEDICATED TO CARE OF THE BABY 7

8. Newborn resuscitation questions for OB Gestational age? Amniotic fluid clear? Number of babies? Any other problems? 8

9. Newborn resuscitation Ask at birth? Term baby? Breathing / crying? Good muscle tone? Yes to all = routine care Dry baby Wipe nose and mouth if needed Skin to skin with mother Observe 9

10. Newborn resuscitation Ask at birth? Term baby? Breathing / crying? Good muscle tone? No to any = put baby under warmer and assess 10

11. Newborn resuscitation suctioning Suction baby ONLY if Airway obstruction is present PPV is needed Routine suctioning of babies can cause Apnea Bradycardia DO NOT USE SUCTIONING TO STIMULATE A BABY TO BREATH 11

12. Newborn resuscitation meconium No suctioning for vigorous baby Suctioning for depressed baby only Suction before stimulation Adjustable suction attached to an ETT 0.5 mm smaller than predicted Do not delay PPV if heart rate is falling During laryngoscopy may decide to intubate with a clean normal size tube 12

13. Newborn resuscitation meconium 13

14. Newborn resuscitation assessment under warmer Dry and stimulate baby Check respirations and HR (not color) By 60 sec after birth suction and start PPV (40-60 breaths/min) for Apnea or gasping or HR < 100 Use Low O2 saturation 14

15. Newborn resuscitation pulse oximetry Target saturations 1 min 60-65% 2 min 65-70% 3 min 70-75% 4 min 75-80% 5 min 80-85% 10 min 85-95% 15

16. Newborn resuscitation PPV Start with AIR with term babies Best to use a PPV device with a pressure gauge 30 cm H20 (term) and 25 cm H20 (premature) Be sure you are ventilating Rising heart rate Chest rise Breath sounds Rising O2 saturation 16

17. Newborn resuscitation ventilation correction steps M - mask adjustment R - reposition baby, shoulder roll Attempt 5-10 breaths S - suction O - open mouth Attempt 5-10 breaths P - pressure of ventilation increase slowly to max of 40 cm H2O A - airway LMA #1 ETT 17

18. Newborn Resuscitation Algorithm. Kattwinkel J et al. Pediatrics 2010;126:e1400-e1413 18

19. Newborn chest compressions: 90 compressions/min + 30 breaths /min 3:1 ratio DO NOT Start Chest compressions unless baby has received 30 sec of Effective ventilation and HR < 60

20. Newborn resuscitation CPR Use 100% O2 with chest compressions Coordinate ventilation and chest compressions Intubation recommended after 30 sec of chest compressions Reassess baby after 45-60 sec of CPR 20

21. Newborn resuscitation epinephrine Used if heart rate is < 60 after 30 sec of PPV and 45-60 sec of PPV and chest compressions Epinephrine 1:10,000 solution (0.1mg/ml) 0.1-0.3 ml/kg IV 0.5-1.0 ml/kg ETT 1.0 ml saline flush Continue CPR Reassess after 60 sec May repeat dose q 5 min 21

22. Newborn resuscitation Volume resuscitation 10 ml/kg IV given over 5-10 min Normal saline Ringers lactate O neg whole blood S u c t i o n w h e n s e c r etion a n d w h e n w e w a n t w e w a n t t o a p p l y P P V w h e n w e c o m p r e s s e R e c o i l _ about cardiac refill d e p t h R a t e d o n 't i n t e r u p t 22