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Resuscitation of the newborn baby

Resuscitation of the newborn baby

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Resuscitation of the newborn baby

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  1. Resuscitation of the newborn baby

  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 NH- 2

  3. Resuscitation: Key words • Anticipation • Preparation • Help • Record • Fast • Gentle • Warmth • Hygiene • Mother NH- 3

  4. Preparing for birth Wash your hands • Draught free, warm room - temperature >250C • Clean, dry and warm delivery surface • Radiant heater • Two clean, warm towels/clothes • A folded piece of cloth • Self inflating bag - newborn size • Infant masks in two sizes - normal and small newborn • Suction device • Oxygen (if available) • Clock NH- Check if all equipments are in working order 4

  5. Assessment at birth • Deliver the baby on to mother’s abdomen • Note and call out 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 NH- 5

  6. Care of the baby at birth Assess breathing: NH- 6

  7. 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 breathing and heart rate was 120/min. • What is the Action? NH- 7

  8. Dry the baby immediately after birth NH- 8

  9. Immediate skin-to-skin Contact & Breastfeeding (routine care) NH- 9

  10. Message 1 ONLY Routine care is required for a baby who is crying or breathing normally; Even routine suctioning is not required for these normal babies NH- 10

  11. 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? NH- 11

  12. 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 NH- 12

  13. Position, clear airways Steps of resuscitation NH- 13

  14. Position, clear airways Steps of resuscitation √ NH- 14

  15. Steps of resuscitation Position, clear airways (if needed) NH- Suction: Do not exceed duration of 20 sec 15

  16. Steps of resuscitation Dry, stimulate, reposition NH- 16

  17. Steps of resuscitation Dry, stimulate, reposition NH- 17

  18. Steps of resuscitation Dry, stimulate, reposition NH- 18

  19. Steps of resuscitation Ventilate(if still not breathing) Selecting Bag & Mask equipment • Size of bag: 240-750 ml • Oxygen capability: Oxygen source, reservoir • Safety feature: Pop off valve, pressure gauge (optional) NH- 19

  20. Steps of resuscitation Ventilate Use the CORRECT size face mask that covers: • The nose • The mouth • The tip of the chin but not the eyes NH- 20

  21. 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 NH- 21

  22. 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 NH- 22

  23. Message 2 Bag and mask ventilation is required for a baby NOT BREATHING or GASPING NH- 23

  24. Steps of resuscitation When to stop ventilating? • 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’ NH- 24

  25. Steps of resuscitation After stopping ventilation • 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 NH- 25

  26. Steps of resuscitation When to continue ventilating? If the baby • is breathing at a rate of <30/min, • is gasping • has severe chest in-drawing • Arrange for immediate referral NH- 26

  27. Steps of resuscitation Referral • 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 NH- 27

  28. 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? NH- 28

  29. No need for intrapartum suction Birth: assess HR, breathing and tone Vigorous: HR>100 good breathing Good tone Nonvigorous: any parameter abnormal NH- Initial steps Tracheal suction 29

  30. Message 3 Meconium stained depressed baby needs endotracheal suction prior to B&MV Routine suction of oro-pharynx is not recommended before delivery of shoulder NH- 30

  31. 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? NH- 31

  32. 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 NH- 32

  33. Message 4 Preterm births need special precautions before and during resuscitation NH- 33

  34. Post resuscitation management Principles Keeping normal temperature Maintaining oxygenation Maintaining physiological milieu- fluids , glucose Maintaining perfusion Treating seizures Monitoring organ function NH- 34

  35. 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 NH- 35

  36. Summary: Steps of resuscitation 1. Keep the baby warm: Place under the radiant heater 2. Open the airway: - Position baby’s head so it is slightly extended - Suction the mouth and then the nose 3. If still not breathing: VENTILATE 4. If breathing or crying begins:STOP VENTILATION

  37. 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. Explain events to the mother and document