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NEONATAL FLOW ALGORITHM

NEONATAL FLOW ALGORITHM. BIRTH. Approximate Time. Term gestation? Amnlotic fluid clear? Breathing or crying? Good muscle tone?u. Routine Care Provide warmth Clear airway if needed Dry Assess color. Yes. No. 30 sec. Provide warmth Position clear airway*

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NEONATAL FLOW ALGORITHM

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  1. NEONATAL FLOW ALGORITHM BIRTH Approximate Time • Term gestation? • Amnlotic fluid clear? • Breathing or crying? • Good muscle tone?u • Routine Care • Provide warmth • Clear airway if needed • Dry • Assess color Yes No 30 sec • Provide warmth • Position clear airway* • (as necessary) • Dry, stimulate, reposition A Breathing, HR>100 & Pink Evaluate respiration heart rate and color Observational Care Breathing, HR>100 but cyanosis Pink Give supplementary oxygen Apneic or HR <100 30 sec Persistent cyanosis Effective Ventilation, HR>100 & Pink Provide positive-pressure ventilation* Post-resuscitation care B HR <60 HR >60 • Provide positive-pressure • ventilation* • Administer chest compression C 30 sec HR <60 Administer epinephrine and/ or volume* D * Endotracheal intubation may be considered at several steps

  2. Key principles • Anticipate • Prepare • Universal precautions

  3. Anticipate • Prepare • Universal precautions

  4. Anticipate • Prepare • Universal precautions

  5. Anticipate • Prepare • Universal precautions

  6. Anticipate • Prepare • Universal precautions

  7. NEONATAL FLOW ALGORITHM BIRTH Approximate Time • Term gestation? • Amnlotic fluid clear? • Breathing or crying? • Good muscle tone?u • Routine Care • Provide warmth • Clear airway if needed • Dry • Assess color Yes No 30 sec • Provide warmth • Position clear airway* • (as necessary) • Dry, stimulate, reposition A Breathing, HR>100 & Pink Evaluate respiration heart rate and color Observational Care Breathing, HR>100 but cyanosis Pink Give supplementary oxygen Apneic or HR <100 30 sec Persistent cyanosis Effective Ventilation, HR>100 & Pink Provide positive-pressure ventilation* Post-resuscitation care B HR <60 HR >60 • Provide positive-pressure • ventilation* • Administer chest compression C 30 sec HR <60 Administer epinephrine and/ or volume* D * Endotracheal intubation may be considered at several steps

  8. NEONATAL FLOW ALGORITHM Approximate Time BIRTH • Term gestation? • Amniotic fluid clear? • Breathing or crying? • Good muscle tone? 30 sec A 30 sec 30 sec

  9. NEONATAL FLOW ALGORITHM Approximate Time BIRTH • Routine Care • Provide warmth • Clear airway if needed • Dry • Assess color • Term gestation? • Amnlotic fluid clear? • Breathing or crying? • Good muscle tone? Yes 30 sec A 30 sec 30 sec

  10. Provide warmth

  11. Provide warmth

  12. Routine care • Wipe secretions • Dry • Assess color

  13. NEONATAL FLOW ALGORITHM Approximate Time BIRTH • Routine Care • Provide warmth • Clear airway if needed • Dry • Assess color • Term gestation? • Amnlotic fluid clear? • Breathing or crying? • Good muscle tone? Yes No 30 sec A • Provide warmth • Position clear airway* • (as necessary) • Dry, stimulate, reposition 30 sec 30 sec

  14. Provide warmth

  15. Provide warmth

  16. Provide warmth

  17. Provide warmth • Avoid hypothermia • VLBW may require special efforts • KMC • Polyethylene bags • Avoid hypothermia

  18. Position,clear airways(as necessary)

  19. Position, clear airways(as necessary)

  20. Position, clear airways(as necessary)

  21. Dry, stimulate, reposition

  22. Dry, stimulate, reposition

  23. Dry, stimulate, reposition

  24. NEONATAL FLOW ALGORITHM Approximate Time BIRTH • Routine Care • Provide warmth • Clear airway if needed • Dry • Assess color • Term gestation? • Amnlotic fluid clear? • Breathing or crying? • Good muscle tone? Yes No 30 sec A • Provide warmth • Position clear airway* • (as necessary) • Dry, stimulate, reposition 30 sec 30 sec

  25. NEONATAL FLOW ALGORITHM Approximate Time BIRTH • Routine Care • Provide warmth • Clear airway if needed • Dry • Assess color • Term gestation? • Amnlotic fluid clear? • Breathing or crying? • Good muscle tone? Yes No 30 sec A • Provide warmth • Position clear airway* • (as necessary) • Dry, stimulate, reposition Breathing, HR>100 & Pink Evaluate respiration heart rate and color Observational Care 30 sec 30 sec

  26. NEONATAL FLOW ALGORITHM Approximate Time BIRTH • Routine Care • Provide warmth • Clear airway if needed • Dry • Assess color • Term gestation? • Amnlotic fluid clear? • Breathing or crying? • Good muscle tone? Yes No 30 sec A • Provide warmth • Position clear airway* • (as necessary) • Dry, stimulate, reposition Breathing, HR>100 & Pink Evaluate respiration heart rate and color Observational Care 30 sec Breathing, HR>100 but cyanosis Pink Give supplementary oxygen 30 sec

  27. Oxygen: term babies • Use 100%:if cyanosis or PPV required • Less than 100%: possibly also effective • If resuscitated with less than 100% oxygen: administer O2 up to 100% if no appreciable improvement within 90 sec following birth • If supplemental O2 is unavailable: use room air

  28. Oxygen: preterms (<32 wk) • Use blender and pulse oximeter • Begin PPV with FiO2 0.21-1.0 • Adjust O2 to achieve SO2 of 95% • Decrease O2 if SO2 above 95%. • If HR <100 bpm: correct ventilation & use 100% O2 • If no facility of blender & pulse ox: manage as term babies • No convincing evidence that a brief period of 100% oxygen during resuscitation will be detrimental

  29. Supplemental oxygen

  30. NEONATAL FLOW ALGORITHM Approximate Time BIRTH • Routine Care • Provide warmth • Clear airway if needed • Dry • Assess color • Term gestation? • Amniotic fluid clear? • Breathing or crying? • Good muscle tone? Yes No 30 sec A • Provide warmth • Position clear airway* • (as necessary) • Dry, stimulate, reposition Breathing, HR>100 & Pink Evaluate respiration heart rate and color Observational Care 30 sec Breathing, HR>100 but cyanosis Pink Give supplementary oxygen Apneic or HR <100 Persistent cyanosis 30 sec Provide positive-pressure ventilation* B

  31. Case - 1 • Term • Liquor clear • Crying • Actively moving

  32. Case 2 • Term • Liquor clear • Poor cry • Limp

  33. Case - 3 • Term woman, early labor • Membranes ruptured and thick meconium revealed • Breathing • Limp

  34. Any difference ? Meconium thick or thin

  35. 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

  36. Tracheal suction • Two persons • Equipments • ETT • Suction • Connections

  37. Tracheal suction • Place under radiant warmer • Postpone drying • Insert laryngoscope • Suction under direct vision • Insert tracheal tube • Apply suction while you withdraw

  38. Initial tracheal suction Minimal meconium Significant meconium Assess HR Initial steps No significant bradycardia Significant bradycardia Repeat tracheal suction

  39. NEONATAL FLOW ALGORITHM Approximate Time BIRTH • Routine Care • Provide warmth • Clear airway if needed • Dry • Assess color • Term gestation? • Amniotic fluid clear? • Breathing or crying? • Good muscle tone? Yes No 30 sec A • Provide warmth • Position clear airway* • (as necessary) • Dry, stimulate, reposition Breathing, HR>100 & Pink Evaluate respiration heart rate and color Observational Care 30 sec Breathing, HR>100 but cyanosis Pink Give supplementary oxygen Apneic or HR <100 Persistent cyanosis 30 sec Provide positive-pressure ventilation* B

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