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Neonatal Resuscitation

Neonatal Resuscitation

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Neonatal Resuscitation

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  1. Neonatal Resuscitation REFERENCES: ILCOR Guidelines – 2005 WHO Regional Credentialing Program Pacific EmOC Program

  2. Objectives • Identify of infants “at risk” for asphyxia • Discuss effects of asphyxia • Describe Resuscitation of newborn • Equipment • Bag and mask ventilation • Cardiac compressions • Post resuscitation care Pacific EmOC Program

  3. How many infants might require active resuscitation? • 10% require some degree of active resuscitation • For up to 50% of this group there are no “risk factors” • Staff attending deliveries may be faced with an unexpectedly “flat” infant Pacific EmOC Program

  4. Maternal diabetes Chronic maternal illness Cardiovascular Thyroid Neurological Pulmonary renal Pre eclampsia Maternal infection Polyhydramnios Oligohydramnios Premature rupture of membranes IUGR/preterm Fetal malformation Maternal substance abuse No antenatal care Post term gestation Multiple gestation Anaemia Age <16 or > 35 Antepartum Risks Pacific EmOC Program

  5. Emergency CS Instrumental delivery Abnormal position Premature labour Precipitous labour Chorioamnionitis Prolonged rupture of membranes Prolonged labour > 24 hrs Prolonged 2nd stage of labour Fetal bradycardia Non-reassuring fetal heart rate pattern General anaesthesia Narcotics administered within 4 hours of delivery Meconium stained liquor Prolapsed cord Abruptio placentae Placenta previa Intrapartum Risks Pacific EmOC Program

  6. Primary apnoea Apnoeic Blue Heart rate  Resuscitate easily Secondary apnoeic White, floppy Heart rate  Blood pressure Require active resuscitation eg IPPV to survive Fetal asphyxia Pacific EmOC Program

  7. Always assume infant has secondary Apnoea & commence Resuscitation Pacific EmOC Program

  8. Radiant warmer Warm towel and blankets Resuscitation bag and mask Self inflating bag Anaesthetic bag Endotracheal tubes Laryngoscope Stethoscope Oxygen source and tubing Suction source and tubing Drugs and fluids Syringes, needles, cannulae, IV lines +/-Umbilical lines Equipment Needed for Resuscitation Pacific EmOC Program

  9. ILCOR Guidelines for Neonatal Resuscitation 2005 Pacific EmOC Program

  10. Steps in Resuscitation - ABCDE • Warmth and stimulation and assessment for the 1st 30 seconds • Use warm cloth • Replace when wet • Rapidly assess • Tone • Colour • Respiratory effort Pacific EmOC Program

  11. Steps in Resuscitation - ABCDE • Airway • Clear airway if required • Removal of secretions if present • Suction mouth and nose (only what you can see) • No more than 5cms for no longer than 5 secs • Negative pressure 100 mmHg (5litres) DO NOT SUCTION IF AIRWAY IS CLEAR • Positioning • Supine or lateral • Head in neutral or slightly extended position Pacific EmOC Program

  12. Steps in Resuscitation - ABCDE • Breathing • Assessment of respiratory effort and colour • Indications for oxygen administration • Cyanosis • Respiratory distress • Give free flowing oxygen 5L/min Pacific EmOC Program

  13. Apnoea Gasping respiration HR < 100 bpm Persistent central cyanosis despite 100% O2 40-60 breaths/min No response Breathing: Indications for positive pressure ventilation Pacific EmOC Program

  14. Steps in Resuscitation - ABCDE • Circulation • Assessment of heart rate and response to previous measures • Umbilical arteries • Apex beat • Auscultation Pacific EmOC Program

  15. HR < 60 bpm despite adequate vent with 100% O2 for 30 seconds 2 techniques 2 thumb (preferred) 2 finger 3:1 ratio 1/3 of AP diameter Chest Compressions Pacific EmOC Program

  16. Steps in resuscitation - ABCDE Drugs • Adrenaline • Volume Expanders • Naloxone Pacific EmOC Program

  17. Adrenaline • HR < 60 bpm after 30 seconds of adequate ventilation and chest compressions • 0.1 - 0.3 mL kg of 1:10,000 • Give via ETT, UVC, IV • Repeat dose if no response after 60 seconds Pacific EmOC Program

  18. Volume expanders • Not given routinely • Useful in hypovolemia • Suspected where there is a pale tachycardic infant • Normal saline • 10mL/kg over 5-10 mins • UVC, IV • If haemorrhagic shock is suspected give whole blood or packed red cells Pacific EmOC Program

  19. Naloxone • Narcotic antagonist • Inadequate spontaneous respiratory effort • Mothers who received narcotics within 4 hrs of delivery • 0.1mg/kg of a 0.4 mg/mL solution • ETT, IV, UVC, IM, SC • Monitor baby’s respirations for further respiratory depression Pacific EmOC Program

  20. Environment Reduce draughts Shut doors and windows Turn on radiant warmer Warm blankets/bunny rugs/hat/plastic wrap for pre terms Steps in resuscitation- ABCDE Pacific EmOC Program

  21. Meconium liquor • ILCOR guidelines 2005 – no evidence to suction mouth and nose on perineum • If baby vigorous and crying - normal care & observation • If baby not vigorous – view cords and suction trachea under direct vision with laryngoscope & mec aspirator or wide bore catheter • Cease suctioning if return is clear or Heart Rate  60 • Observe post resuscitation for signs of respiratory distress Pacific EmOC Program