Neonatal Resuscitation Program eighth edition.pptx

Neonatal resuscitation program 8th edition

1. Neonatal Resuscitation Program 8 th edition Dr. Renold S. Xavier

2. Why? Most newborns make the transition to extrauterine life without intervention 5% of term NB- PPV 2% of term NB- intubated 1 to 3 per 1000 births- CC or emergency medications

3. Preparing for resuscitation Team and equipment preparation: the “brief” 4 pre-birth questions Expected gestational age Is the AF clear ? Any additional risk factors? Umbilical cord management plan

4. Timing of umbilical cord clamping DCC for 30-60 s is reasonable for both term and preterm infants who do not require resuscitation at birth.

5. Increased venous return to the right atrium enters PFO and aorta Umbilical cord milking Pulmonary vasoconstriction Lack of cerebral autoregulation and right to left ductal shunt result in fluctuations in flow to an immature brain with fragile germinal matrix. IVH Hemodynamic Changes During Cord Milking

6. The “Golden minute” Textbook of Neonatal Resuscitation, 8th Ed. By American Academy of Pediatrics and American Heart Association. Edited by Gary M. Weiner and Jeanette Zaichkin

7. Routine care

8. Sniffing the morning air position

9. Ventilation is key MR.SOPA if no ↑ HR/no chest movement after 15 secs If HR low despite ventilation, alternate airway and 30 secs PPV Saturation targets unchanged

10. Ventilation of the newborn's lungs is the single most important and effective step in neonatal resuscitation

11. 40 to 60 breaths per minute Breathe, two, three; breathe, two, three ; breathe, two , three

12. lnitial Settings for Positive-Pressure Ventilation

13. MR. SOPA

14. lnitial Settings for Positive-Pressure Ventilation

15. Endotracheal intubation

16. Endotracheal intubation

17. Chest compressions 30 seconds PPV via AA 90 compressions per minute and the breathing rate is 30 breaths per minute One-and-Two and- Three-and-Breathe-and .... 100 % FiO2 60 seconds- reassess Textbook of Neonatal Resuscitation, 8th Ed. By American Academy of Pediatrics and American Heart Association. Edited by Gary M. Weiner and Jeanette Zaichkin

18. CARDIO

19. Medications Epinephrine IV/IO dose range 0.01-0.03mg/kg Suggested initial IV/IO =0.02mg/kg. Suggested initial ET dose =0.1mg/kg ( no max. dose) Flush with 3 ml normal saline Can repeat every 3-5 mins: “consider ↑subsequent doses ” Consider pneumothorax/hypovolemia

20. Volume expansion recommendations a . Solution: Normal saline (NS) or type O Rh-negative blood b. Route: Intravenous or intraosseous c. Preparation: 30- to 60-mL syringe (labeled NS or O- blood) d. Dose: 1O mL/kg e. Rate: Over 5 to 1O minutes

21. Normal saline remains crystalloid expander of choice Packed cells in cases of suspected fetal anemia “Reasonable time frame for considering cessation of resuscitation efforts is around 20 minutes after birth”…. “individualized based on patient and contextual factors”

22. A baby who required resuscitation must have close monitoring and frequent assessment of respiratory effort, oxygenation, blood pressure , blood glucose, electrolytes, urine output, neurologic status , and temperature during the immediate neonatal period . Be careful to avoid overheating the baby during or after resuscitation. If indicated, therapeutic hypothermia must be initiated promptly; therefore , every birth unit should have a system for identifying potential candidates and contacting appropriate resources. POST RESUSCITATION CARE

23. Thank you