Neonatal Resuscitation

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Neonatal Resuscitation

• -BLS-
• RC 290

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Equipment Needed

• Overhead radiant warmer
• Bulb syringe
• BVM with heated humidified O2
• De Lee suction device
• Size 5 Fr suction catheters and wall suction
• Laryngoscope with proper sized blades
• Proper sized ET tubes
• Crash cart/Drug box

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Normal Delivery Procedures

• Place under warmer and towel dry
• Use bulb syringe to clear mouth, than nose
• Tactile stimulation if not breathing yet
• Auscultate heart and lungs assess color
• Prophylactic silver nitrate or erythromycin drops
  in eyes
• Vitamin K injection
• Examine umbilical cord
• Free flow O2 as needed

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Free Flow O2
Hold O2 connecting tubing ½ inch from infants
face. Run flow at 5 LPM
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Resuscitation

• Maternal causes
• Drugs
• Cardiopulmonary problems
• Infection
• Dystocia
• Utero-Placental problems

• Fetal Causes
• Cord compression
• Prematurity
• Congenital anomalies
• Multiple pregnancy
• Meconium aspiration
• Hypothermia
• shock

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NRP Resuscitation Algorithm
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Meconium Baby

• Airway is aggressively cleared prior to drying if
  infant is meconium stained AND baby is NOT
  vigorous!
  
• Use ET tube as a suction device
• May need PD P after heart rate, respirations,
  and color stabilize
• If baby is meconium stained but vigorous, proceed
  with normal resuscitation

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Bagging a Neonate
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BVM Devices
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BVM Devices
Flow-dependent anesthesia bag
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Bagging Technique

• Place infant in sniffing position by placing a
  small towel under the shoulders
• Do not hyperextend neck!

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Bagging technique (cont.)

• Apply correctly sized mask over infants mouth and
  nose with apex of mask over bridge of nose

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• Run either type of bag at 5-8 LPM to get 100
  FIO2
• If self-inflating bag, use reservoir also
• Watch for slight rise of chest (Vt 20-30 ml)
• Rate is 40-60
• Pressure
• First breath may require 30-40 cmH2O
• Then, with normal lungs, 15-20 cmH2O
• Poor lung compliance may require sustained 20-40
  cmH2O

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If BVM ventilation lasts over 2 minutes

• Than an orogastric tube has to be inserted

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Neonatal PD P

• Meconium babies and/or C section babies
• No more than 20 degrees of Trendelenberg or ICP
  will increase
• Percuss anterior and lateral surfaces 1-2 minutes

• Maintain airway throughout using one hand on head
• Suction PRN
• Besides suction, need BVM and O2
• Monitor heart rate, respirations and color
  throughout

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Neonatal PD P Percussors
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Neonatal Chest Compressions

• Asystole or bradycardia less than 60 that is not
  increasing with airway and ventilation
• Use thumbs on lower half of sternum (one fingers
  width below nipple line)
• Compress ½ to ¾ of an inch, 120 times per minute
• Compression ventilation ratio is 31 (pause to
  give breath)

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The End Result