resuscitation of neonate .pptx

resuscitation of neonate
done by Dr.ali obaid
Pediatric Iraqi board

1. Call of day 18/02/2023 Toal delivary = 23 NVD = 10 C/S = 13 ADMISSION = 0 Senior call is Dr.Ahmed

2. Resuscitation of newborn Done by :- Dr.Ali O baid

3. References :- Nelson Essentials of Pediatrics 21th edition 2022 .

4. Introduction Series of actions, used to assist newborn who have difficulty with making the physiological ‘transition’ from the intrauterine to extrauterine life. Approximately 5-10% of newborns require active resuscitation to prevent birth asphyxia. High-risk situations should be anticipated by the hx of pregnancy, labor, and delivery .

5. Neonatal resuscitation Neonatal resuscitation is generally follow the basic rule (ABC ) :- A : anticipate and establish patent airway by suctioning and, if necessary , by performing endotracheal intubation . B : initiate breathing by using tactile stimulation or positive-pressure ventilation with bag and mask . C : maintain the circulation by chest compression and medications.

6. Apgar score

7. Apgar score the 1-min Apgar score may signal the need for immediate resuscitation. The 5-, 10-, 15-, and 20-min scores may indicate the probability of successfully resuscitating an infant or not

8. newborns with high apgar scores (>7) may also need only the routine care by :- warm , dry the infant & clear his airway (if needed By suctioning oro -pharyngeal and nasal secretion by using suction catheter . Introduce the catheter about 5cm into the mouth and 3cm into the nose.

9. If the newborn has low apgar scores (≤ 7), start active resuscitation according to the following steps:-

10. Place the newborn warming (to prevent hypothermia), supplemental oxygen , put the head down with slight extension, clear the airway by suctioning and provide gentle tactile stimulation (e.g . slapping the feet, rubbing the back ). These measures should take 30 sec , then reassess , if apgar scores become higher, stop resuscitation , whereas if still low shift to step 2 . Step 1

11. Provide positive pressure ventilation through a tightly fitted face mask and bag ( ambu bag ) with continuous SPO2 monitoring by pulse oxymeter * . These measures should also take 30 sec , then reassess , if apgar scores become higher, consider CPAP & continue SPO2 monitoring till complete recovery. whereas if apgar scores are still low, shift to step 3 . Step 2

12. Age SPO2  1 min 60-65%  2 min 65-70%  3 min 70-75%  4 min 75-80 %  5 min 80-85 %  10 min 85-95 % ___________________________________ The American Heart Association American Academy of Paediatrics . * SPO 2 with first minuts of newborn

13. Provide positive pressure ventilation through endotracheal tube (ET) * If HR <60 beat/min initiate chest compression over the lower third of the sternum at a rate of 90/min & the ventilation is 30/min with 100% O2 (i.e. ratio of compression to ventilation 3:1) for 1 min then reassess , if apgar scores become higher, consider CPAP with continuous SPO2 monitoring till complete recovery, whereas if still low, shift to step 4 . Step 3

14. * ET The ET tube size & depth of insertion (from upper lip) should be according to the birth weight as follows :- BW (kg) Size (mm) Depth(cm ) < 1 2.5 6.5-7 1-2 3 7-8 2-3 3-3.5 8-9 >3 3.5-4 ≥9 ensure equal air entry in both lungs by auscultation in the lateral or posterior aspect of chest .

15. Give Adrenaline either through the umbilical vein or via the ETT in a dose 0.1-0.3 ml/kg I.V or 0.5-1 mL/kg intratracheally . It can be repeated every 3-5 min if the newborn is unresponsive. If adequate resuscitation continues for 10 min without a detectable heart rate, it is reasonable to stop resuscitative efforts . Step 4

16. Drugs may be use in the r esuscitation Before initiating drug treatment, one should check the following: › Whether the air way is open. › Whether the chest inflates with each ventilation . › Whether chest compression given properly . › If the newborn does not respond even after the airway is open the chest moves easily with Ventilation , and effective chest compressions has been given, only then the drugs may help.

17. Volume expander : when blood loss in known or suspected ( Pale skin, weak pulse, poor perfusion and heart rate not responding adequately to the other resuscitative measures) . an isotonic crystalloid solution or blood 10ml/kg is recommended which may need to be repeated . Volume expanders should be infused very slowly to the premature babies . If infused rapidly that may cause hypertension & Intra ventricular hemorrhage .

18. Intravenous glucose administration should be considered as soon as after resuscitation with the goal of avoiding hypoglycemia . Sodium bicarbonate : Sodium bicarbonate is usually not useful during the acute phase of neonatal resuscitation. Without adequate ventilation and oxygenation it will not improve the blood pH and may worsen cerebral acidosis. After prolong resuscitation sodium bicarbonate may useful in correcting documented metabolic acidosis

19. Finally, if newborn is survived after these measures, search for all manifestations of multi-organ hypoxic-ischemic injury (especially the brain ) & manage them accordingly .

20. DO NOT DO Harmful Action Consequences Slapping the back  Bruising Squeezing the rib cage  Fractures  Holding upside down and shaking  Intraventricular bleeding, pneumothorax, death.