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Neonatal Resuscitation

Neonatal Resuscitation. Mary P. Martinasek, BS, RRT Director of Clinical Education Hillsborough Community College. Asphyxia. Hypoxia + Hypercapnia + Acidosis May lead to irreversible brain damage The necessity to resuscitate is related to the degree of asphyxia. Causes of fetal asphyxia.

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Neonatal Resuscitation

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  1. Neonatal Resuscitation Mary P. Martinasek, BS, RRT Director of Clinical Education Hillsborough Community College

  2. Asphyxia • Hypoxia + Hypercapnia + Acidosis • May lead to irreversible brain damage • The necessity to resuscitate is related to the degree of asphyxia

  3. Causes of fetal asphyxia • Maternal hypoxia • Insufficient placental blood flow • Blockage of umbilical blood flow • Fetal disorders

  4. Primary vs. Secondary Apnea • Primary • Initial asphyxia • Signs • Initial period of rapid breathing • Respiratory movements cease • Heart rate and bp drop • Neuromuscular tone diminishes

  5. Secondary Apnea • If no resuscitation and apnea continues • Signs • Deep gasping respirations • Heart rate continues to decrease • Blood pressure begins to fall • Infant flaccid

  6. Primary Stimulation and oxygen will usually induce respirations Secondary Infant unresponsive to stimulation – must be resuscitated

  7. Effects of asphyxia on the lungs • Ineffective respirations cannot open alveoli • Pulmonary Hypertension • Pulmonary vasoconstriction • Hypoxia, hypercarbia, acidosis

  8. Persistent Fetal Circulationknown as PPHN • Leads to further asphyxia • Blood shunted • CO2 remains high despite ventilation • Indocin • Ligation of PDA

  9. Preparation for Resuscitation • Anticipation of high risk delivery • Proper equipment • Trained personnel

  10. Purpose of Resuscitation • Reverse asphyxia before irreparable damage has occurred

  11. ABC’s of Resuscitation • A – Establish an open airway • Position infant • Suction mouth then nose • B – initiate breathing • Use tactile stimulation • Use PPV if necessary

  12. Resuscitation • C – Maintain circulation • Stimulate and maintain circulation • Chest compressions • drugs

  13. Initial steps • Dry the infant • Warm the infant • Position the infant • Suction the infant • Stimulate the infant

  14. Next step • Evaluate respirations • If none or gasping , provide PPV with 100% O2 for 15-30 seconds • If spontaneous respirations then evaluate HR

  15. Next • After 15-30 seconds of PPV or evaluation of spontaneous respirations then: • EVALUATE HEART RATE • If HR is above 100 then reevaluate respirations and color • If HR is less than 60 continue/start PPV and start compressions

  16. Reassess • After 30 seconds reassess • HR greater than 60 stop compressions • HR greater than 100 and breathing stop PPV • Evaluate infant’s color • Peripheral vs. central cyanosis • What is acrocyanosis?

  17. Thermoregulation • Maintain a neutral thermal environment • Possible causes of heat loss • Radiant • Evaporative • Convective • Conductive

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