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Neonatal Resuscitation

Neonatal Resuscitation

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Neonatal Resuscitation

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  1. Neonatal Resuscitation Joseph Gilhooly, MD Doernbecher Children’s Hospital

  2. NRP 2001

  3. Resuscitation Algorithm: 2001

  4. Why we need to resuscitate: pH 7.30 pH 7.00 pH 6.80

  5. How often do we use our resuscitation skills?

  6. Suction Equipment Warmer & Blankets Bag, Mask, & Oxygen Laryngoscope and ETT Tube

  7. Universal Precautions

  8. Assessment: Then • Appearance • Pulse • Grimace • Activity • Respirations

  9. Assessment: Now Physiologic Parameters (Apgar’s best) • Breathing • Heart Rate • Color Questions to ask yourself • Clear of Meconium? • Breathing or Crying? • Good Muscle tone? • Color Pink? • Term Gestation?

  10. Initial Management: For all deliveries • Provide warmth • Position and Clear Airway • Dry • Give Oxygen (as necessary)

  11. Providing Warmth: The cycle of hypothermia Acidosis Pulmonary Vasoconstriction Anaerobic metabolism Pulmonary Hypertension Tissue hypoxia Right to left shunting Hypoxemia

  12. Positioning: Sniffing

  13. The “Trusty” Bulb Syringe

  14. Clear of Meconium?

  15. Color pink?

  16. Pulse Oximetry: Resuscitation monitor • Not affected by acrocyanosis • Be patient and get a reading • If baby in shock, get central IV access

  17. Breathing or Crying? • Indications for PPV • Apnea or gasping • Heart rate <100 even if breathing • Persistent central cyanosis (saturation <90%) despite 100% free-flow oxygen

  18. Self-Inflating Bag O2 Reservoir Pressure manometer attaches PEEP valve port 200-750ml Bag size

  19. Neopuff • CPAP • Pressure limited ventilation with PEEP • Blended oxygen • Eliminates variability associated with bag ventilation

  20. Masks Smallest sizes are for preterm infants

  21. Make sure the airway is clear • Lift the baby’s jaw into the mask • Keep the mouth slightly open Rate 40-60

  22. Indications for Intubation • Meconium and baby is not vigorous • PPV by bag-mask does not result in good chest rise • PPV needed beyond a few minutes • Chest compressions necessary • Route to administer epinephrine • Special indications: Prematurity, CDH

  23. Miller 0 Miller 1

  24. >2000 gm 3.5 3.0 1000-2000 gm 2.5 <1000 gm Stylet

  25. Intubation Technique

  26. Lip reference mark: (6 + weight in kilos) cm 9-10 cm at the lip for this term infant

  27. Heart rate <60 bpm after 30sec of PPV Coordinate with ventilation 4 events in 2 seconds 90 compressions and 30 breaths per minute Indications for Compressions One and Two and Three and Breathe 2 seconds

  28. Compressions 2 thumb technique preferred

  29. Medications: Epinephrine • Indication: Heart rate <60 after 30 sec of coordinated ventilation and compressions • 1:10,000 (0.1mg/ml) • Route: ETT or IV • 0.1-0.3 ml/kg • 1ml Term • 0.5ml Preterm • 0.25ml Extreme preterm

  30. Extended Algorithm • Endotracheal Intubation if not already accomplished • Establish IV access with UVC • Stat CXR • Discontinue efforts if no heart rate after 15 minutes

  31. IV Access: “Low” UVC

  32. Volume • Indication: No response to resuscitation and evidence of blood loss • Normal Saline • Ringers or Blood as alternatives • 10 ml/kg, may repeat • Route: IV (Umbilical vein)

  33. Sodium Bicarbonate • Indication: Documented or assumed metabolic acidosis • Concentration: 4.2% NaHCO3 (0.5meq/ml) • Dose: 2meq/kg • Route: IV (Umbilical vein)

  34. Naloxone (Narcan) • Indication: Severe respiratory depression after PPV has restored a normal HR and color and… • History of maternal narcotic administration within the past 4 hours • Dose: 0.1mg/kg of 1mg/ml solution • Route: ETT, IV, IM, SQ

  35. Hypoglycemia • Blood Glucose <45-60 • 5cc/k D10W • Route IV