Newborn resuscitation ppt for health care professionals

neonatal resuscitation

1. Newborn resuscitation
programme(NRP)
Renu Singh

2. Burden of the problem
•Birth asphyxia
•23% of the 1 million neonatal deaths in India
•Long term neurological complications
•Death
•NNR (Neonatal resuscitation) :simple,
inexpensive, cost effective method
•Problem: NNR often not initiated, incorrect
use of methods

3. The Golden minute
•The “first minute after birth”
•Anxiety for parents, health providers
•Period of transition from intrauterine to extra
uterine life
•Major: No/minimal assistance
•10%: assistance to begin breathing at birth
•1%: extensive resuscitative measures
•First Golden Minute Project: skill based training

4. Successful NNR: factors
•Anticipation: call a skilled personnel
•Adequate preparation
•Accurate evaluation, algorithm based
•Prompt initiation of support

6. Resuscitation: initial steps
•Provide warmth
•Head position “ sniffing position”
•Clearing the airway
•Drying the baby
•Tactile stimulation for breathing

7. Sniffing position
Extension of neck with help shoulder roll:: to
open the airway

8. Newly born infant
•Specifically the Infant at time of birth
•(A)Do not require resuscitation
•(B)Require resuscitation
•Rapid assessment of 3 characters
–Term gestation?
–Crying or breathing?
–Good muscle tone?

9. Newly born infant
Term gestation?
Crying or breathing?
Good muscle tone?
YES :Do not require resuscitation
–Dry
–Skin to skin contact
–Covered with dry linen to maintain
temperature
–Ongoing observation: breathing, color, activity

10. Newly born infant
Term gestation?
Crying or breathing?
Good muscle tone?
NO :require resuscitation; One/more of the
following actions in sequence
–Initial steps in stabilization(warmth, clear
airway, dry, stimulate)
–Ventilation
–Chest compressions
–Administration of epinephrine& /or volume
expansion

11. AAP
Algorithm

12. IAP
Algorithm

13. The golden minute
•<30 seconds: complete initial steps
•Warmth
•Drying
•Clear airway if necessary
•Stimulate
•30-60 seconds: assess 2 vital characteristics
•Respiration (apnea/gasping/labored/unlabored)
•Heart rate (<100/>100bpm)

14. <60 seconds of birth
•If gasping/apnea
If heart rate<100 beats per minute
PPV( positive pressure ventilation)
Spo2 monitoring by pulse oximeter
•Simultaneous evaluation of 3 vitals
•Heart Rate,
•Respiration,
•oxygenation status

15. Targeted SPO
2 after birth
1 minute 60-65%
2 minutes 65-70%
3 minutes 70-75%
4 minutes 75-80%
5 minutes 80-85%
10 minutes 85-90%

16. Increase in heart rate is the most
sensitive indicator of a successful
response to each step practiced

17. PPV: Positive pressure ventilation
•Form of assisted ventilation
•Needed when there is no improvement in HR
•Also assess chest wall movements
•Should be delivered at rate of 40-60
breaths /min, maintain HR>100 /min
•Devices: BMV, ET (endotracheal
tube),LMA(laryngeal mask airway)

18. Bag & mask ventilation

19. Endotracheal tube
•Initial endotracheal suctioning of non vigorous
meconium stained newborn
•If BMV is ineffective/prolonged
•When chest compressions are performed

20. Endotracheal tube

21. LMA(Laryngeal mask airway)
•Fits over laryngeal inlet
•Done when BMV is unsuccessful
•When tracheal intubation is unsuccessful or
not feasible

22. LMA(Laryngeal mask airway)

23. Chest compressions
•Started when HR<60 per minute despite adequate
ventilation with 100% oxygen for 30 sec
•Delivered at lower third of sternum, to depth 1/3 of
AP diameter of chest
•2 techniques:
–2 thumb-encircling hands technique
–Compression with 2 fingers ,second hand
supporting the back
–3:1 ratio::[ 90 comp:30 ventilations]

24. Chest compressions

25. medications
•Rarely indicated
•Most important step to treat bradycardia is
establishing adequate ventilation
•HR remains <60bpm,despite adequate
ventilation(ET) with 100% Oxygen & chest
compressions
•Epinephrine or volume expansion or both

26. Epinephrine
•Route of administration: intravenous(IV),ideal
•Recommended dose: 0.01-0.03 mg/kg per
dose
•Desired concentration: 1:10,000
0.1 mg/ml

27. Volume expansion
•Suspected or known blood loss
•Isotonic crystalloid solution
•Blood
•Dose calculation: 10 ml/kg

29. Post resuscitation care
•Needed for those who required PPV
•At risk of deterioration
•Need monitoring ,evaluation
•NICU may be necessary

30. NNR : not indicated
•Conditions with certainly early death
•Extreme prematurity(GA<23 weeks)
•Birth weight<400g
•Anencephaly
•Chromosomal abnormality: Trisomy 13

31. NNR: nearly always indicated
•High rate of survival
•Acceptable morbidity
•GA≥ 25 weeks
•Those with most congenital malformations

32. NNR?
•Conditions associated with uncertain
prognosis
•Survival borderline
•Parental desires concerning initiation of
resuscitation should be supported

33. Discontinuing resuscitative efforts
•Newly born baby with no detectable heart
rate, consider stopping NNR if the heart rate
remains undetectable for 10 minutes

34. MCQ1
For successful neonatal resuscitation following
is/are needed except:
1.Anticipation
2.Adequate preparation
3.Skilled personnel
4.Delayed initiation of support

35. MCQ1
• For successful neonatal resuscitation
following is/are needed except:
1.Anticipation
2.Adequate preparation
3.Skilled personnel
4.Delayed initiation of support

36. MCQ2
•Following are true in relation to initial steps of
neonatal resuscitation except
1.Provide warmth
2.Tactile stimulation
3.Clear airway and intubation
4.Drying the baby

37. MCQ2
•Following are true in relation to initial steps of
neonatal resuscitation except
1.Provide warmth
2.Tactile stimulation
3.Clear airway and intubation
4.Drying the baby

38. MCQ3
•The following is the primary measure of
adequate ventilation
1.Chest wall movement
2.Improvement in heart rate
3.Pink extremities
4.Spo2 of 80%

39. MCQ3
•The following is the primary measure of
adequate ventilation
1.Chest wall movement
2.Improvement in heart rate
3.Pink extremities
4.Spo2 of 80%

40. MCQ4
•Endotracheal intubation may be indicated at
several points during neonatal resuscitation
except
1.If BMV is ineffective
2.When chest compressions are performed
3.Endotracheal suctioning of vigorous meconium
stained newborns
4.For special resuscitation circumstances like
extremely LBW

41. MCQ4
•Endotracheal intubation may be indicated at
several points during neonatal resuscitation
except
1.If BMV is ineffective
2.When chest compressions are performed
3.Endotracheal suctioning of vigorous meconium
stained newborns
4.For special resuscitation circumstances like
extremely LBW

42. MCQ5
•The recommended compression to ventilation
ratio in neonatal resuscitation is
1.2:1
2.3:1
3.4:1
4.5:1

43. MCQ5
•The recommended compression to ventilation
ratio in neonatal resuscitation is
1.2:1
2.3:1
3.4:1
4.5:1

44. MCQ6
•The recommended dose(mg/kg per dose) and
route of epinephrine in neonatal resuscitation
1.0.01-0.03,IV
2.0.01-0.03,IM
3.0.03-0.05,1V
4.0.05-0.1,IV

45. MCQ6
•The recommended dose(mg/kg per dose) and
route of epinephrine in neonatal resuscitation
is
1.0.01-0.03,IV
2.0.01-0.03,IM
3.0.03-0.05,1V
4.0.05-0.1,IV

46. MCQ7
•Recommended method/clinical indicator of
confirming ET placement is
1.Condensation in ET
2.Chest movement
3.Equal breath sounds on auscultation
4.Exhaled C0
2 Detection

47. MCQ7
•Recommended method/clinical indicator of
confirming ET placement is
1.Condensation in ET
2.Chest movement
3.Equal breath sounds on auscultation
4.Exhaled C0
2 Detection