Resuscitation.ppt

Resuscitation

1. Resuscitation of the
newborn baby
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2. Learning objectives
To assess a newborn baby at birth
To perform basic resuscitation of a newborn
baby using standard equipment
Resuscitation in special situations: meconium
stained liquor and preterm birth
To learn principles of aftercare for a baby who
requires resuscitation at birth
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3. Preparing for birth
Washyourhands
Draughtfree,warmroom-temperature>25
0
C
Clean,dryandwarmdeliverysurface
Radiantheater
Twoclean,warmtowels/clothes
Afoldedpieceofcloth
Selfinflatingbag-newbornsize
Infantmasksintwosizes-normalandsmallnewborn
Suctiondevice
Oxygen(ifavailable)
Clock
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Check if all equipments are in working order

4. Assessment at birth
Deliver the baby on to mother’s abdomen
Note and record time of birth
Thoroughly dry the baby
Use a warm towel
Discard wet towel after drying
Wrap the baby in another warm cloth
Keep the baby warm
Assess breathing while drying
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5. Care of the baby at birth
Assess breathing:
Assessment Decision
Baby is crying No need for resuscitation or
suctioning;
Startskin-to-skin contact and
breastfeeding
Baby is not crying, but breathing
at 30 to 60 times per minute
No need for resuscitation or
suctioning
Baby is gasping Start resuscitation immediately
Baby is not breathing Start resuscitation immediately
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6. Scenario 1
A mother arrived at your maternity hospital and
delivered a baby girl as soon as she reached the
labor ward. The placenta followed the baby and
mother was not bleeding.
The baby was pale. He was breathingand heart
rate was 120/min.
What is the Action?
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7. Dry the baby
immediately after
birth
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8. Immediate
skin-to-skin
Contact &
Breastfeeding
(routine care)
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9. Message 1
ONLY Routine careis required for a baby who is
crying or breathing normally;
Even routine suctioningis not required for these
normal babies
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10. Scenario 2
A baby girl is born at your clinic after second stage of
60 minutes. The umbilical cord is short.
You see that the skin is pale .She is not breathing.
Heart rate is over 100/min.
What is the Action?
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11. Steps of resuscitation
If the baby is not breathing or gasping
Call for help!
Cut cord quickly, transfer to a firm, warm
surface [under a radiant heater]
Inform the mother that baby has difficulty
breathing and you will help the baby to breathe
Start newborn resuscitation
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12. Position, clear airways
Steps of resuscitation
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13. Position, clear airways
Steps of resuscitation
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14. Position, clear airways (if needed)
Steps of resuscitation
Suction: Do not exceed duration of 20 sec
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15. Dry, stimulate, reposition
Steps of resuscitation
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16. Dry, stimulate,reposition
Steps of resuscitation
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17. Dry, stimulate, reposition
Steps of resuscitation
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18. Selecting Bag & Mask
equipment
Size of bag: 240-750 ml
Oxygen capability: Oxygen
source, reservoir
Safety feature: Pop off valve,
pressure gauge (optional)
Ventilate(if still not breathing)
Steps of resuscitation
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19. Use the CORRECT size face
mask that covers:
The nose
The mouth
The tip of the chin
but not the eyes
Ventilate
Steps of resuscitation
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20. Fitting a face mask:
A face mask that is too LARGE
Covers the eyes
Extends over the tip of the chin
A face mask that is too SMALL
Does not cover the nose
Does not cover the mouth effectively
Steps of resuscitation
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21. Squeeze bag with 2 fingers or whole
hand, 2-3 times
Observe for rise of chest
IF CHEST IS NOT RISING:
Check seal
Reposition the head
Squeeze harder
Once good seal and chest rising,
ventilate at 40 squeezes per minute
Observe chest rise
Check heart rate after 30 seconds
Steps of resuscitation
Ventilate
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22. Message 2
Bag and mask ventilation is required for a baby
NOT BREATHING or GASPING
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23. If baby is crying;
If breathing >30/min, and
NO chest in-drawing:
If the skin between the ribs is
‘sucked’ inwards and the ribs
are prominent, the baby has
chest ‘in-drawing’
Steps of resuscitation
When to stop ventilating?
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24. Put the baby in skin-to-skin contact on mother’s
chest
Monitor every 15 minutes for breathing and
warmth
Tell the mother the baby will probably be well
Encourage the mother to start breastfeeding as
soon as possible
NEVERleave the baby alone
Steps of resuscitation
Afterstopping ventilation
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25. If the baby
is breathing at a rate of <30/min,
is gasping
has severe chest in-drawing
Arrange for immediate referral
Steps of resuscitation
When to continue ventilating?
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26. Explain to the mother what happened, that her
baby needs help with breathing
Ventilate during the referral
Record the event on a referral form and labour
record
If the baby is NOT breathing even after 20 minutes,
STOP ventilating
Steps of resuscitation
Referral
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27. Scenario 3
Baby girl born at 38 weeks following thick
meconium stained amniotic fluid is noted
to be limp and not breathing.
The baby is blue. She was not breathing and heart
rate was 80/min.
What is the Action?
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28. No need for intrapartum suction
Birth: assess
HR, breathing and tone
Vigorous: HR>100
good breathing
Good tone
Nonvigorous: any
parameter abnormal
Initial steps Tracheal suction
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29. Message 3
Meconium stained depressed baby needs
endotrachealsuction prior to B&MV
Routine suction of oro-pharynx is not
recommendedbefore delivery of shoulder
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30. Scenario 4
Mother admitted in maternity unit delivered a
baby boy at 32 week gestation on bed. The
baby is limp and not breathing.
The baby is pale. He is not breathing and HR is
80/min.
What is the Action?
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31. Be gentle
Use small size resuscitation bag and give small tidal
volumes to move chest
Avoid 100% oxygen , use blenders and oxygen
saturation monitors
Avoid rapid fluid bolus
May need intubation, chest compression, medications
Keep CPAP back up ready
Steps of resuscitation
Special considerations for preterm
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32. Message 4
Pretermbirths need special precautions before
and during resuscitation
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33. Post resuscitation management
Principles
1.Keeping normal temperature
2.Maintaining oxygenation
3.Maintaining physiological milieu-fluids , glucose
4.Maintaining perfusion
5.Treating seizures
6.Monitoring organ function
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34. Care after resuscitation
Place baby in skin-to-skin contact with mother
Keep the baby warm
Monitor every 15 minutes
Start breastfeeding as soon as possible
Discuss what has happened with the parents -be
positive!
Do not separate the mother and baby unless the baby
has difficult breathing
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35. Summary: Steps of resuscitation
1. Keep the baby warm:Place under the radiant
heater
2.Opentheairway:
-Positionbaby’sheadsoitisslightlyextended
-Suctionthemouthandthenthenose
3.Ifstillnotbreathing:VENTILATE
4. If breathing or crying begins:STOP
VENTILATION
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36. Summary: Steps of resuscitation
5. If breathing at <30 breaths per minute or there
is severe chest in-drawing: CONTINUE
VENTILATION
6. If no breathing or gasping after 20 minutes of
ventilation: STOP VENTILATION
7.Explaineventstothemotheranddocument
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