NEONATAL RESUSCITATION

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NEONATAL RESUSCITATION

• PRESENTED BY
• PHATTRAPONG TANSUPOL MD.

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• 1.???????????????????
• 2.????????
• 3.???????????????
• 4.ACTION/EVALUATION/DECISION CYCLE
• 5.????????????????? ??????????????

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ACTION/EVALUATION/DECISION CYCLE

• EVALUATION
• ACTION DECISION

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ASPHYXIA THE BASIC

• 1.Primary Apnea  When asphyxiated, the infant
  responds with a increased RR.  If the episode
  continues, the infant becomes apnic, followed by
  a drop in HR and a slight increase in BP.The
  infant will respond to stimulation and therapy
  with spontaneous respirations.

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• 2. Secondary apnea after primary apnea,  the
  infant responds with a period a gasping
  respirations, falling HR, and falling BP.The
  infant takes a last breath and then enters the
  secondary apnea period.The infant will not
  respond to stimulation and death will occur
  unless resuscitation begins immediately.
•   Because after delivery of an infant it is
  impossible to differentiate between primary apnea
  and secondary apnea, assume the infant is in
  secondary apnea and begin resuscitation
  immediately.

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ASPHYXIA CHANGE
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APGAR SCORE
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Anticipation and Recognition of the Neonate in
Distress 1.Antepartum and intrapartum history
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1.Antepartum and intrapartum history CONT.
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Equipment

• Equipment and medications should be checked as a
  daily routine and then prior to anticipated need.
  Used items should be replenished as soon as
  possible after a resuscitation.
• The delivery room should be kept relatively warm
  and the radiant heater should be preheated when
  possible. Prewarming of towels and blankets can
  also be helpful in preventing excessive heat loss
  from the neonate.

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Equipment

• SUCTION EQUIPMENT
• BULB SYRINGE
• SUCTION CATH NO 5 6 8 10 Fr
• 8 Fr FEEDING TUBE 20 ml SYRINGE
• MECONIUM ASPIRATOR
• BAG-MASK EQUIPMENT
• FACE MASK
• ORAL AIRWAY
• OXYGEN

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Equipment CONT.

• INTUBATION EQUIPMENT
• LARYNGOSCOPY-BLADE NO 0-1
• BATTERY FOR LARYNGOSCOPE
• ETT NO 2.5 3.0 3.5 4.0 mm
• STYLET SCISSOR GLOVE
• MISCELLANEOUS
• RADIANT WARMER-STETHOSCOPE-TAPE-
• SYRINGE-NEEDLE-ALCOHOL-UMBILICAL CATH

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Initial Steps for Neonatal Resuscitation in
Delivery Room

• ANTICIPATION
• ASSESSMENT OF ACTION
• 1.PREVENT HEAT LOSS
• Place the infant under an overhead radiant heater
  to minimize radiant and convective heat loss.
• Dry the body and head to remove amniotic fluid
  and prevent evaporative heat loss. This will also
  provide gentle stimulation to initiate or help
  maintain breathing.

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Initial Steps for Neonatal Resuscitation in
Delivery Room CONT.

• 2.ABCDE STEP
• A-AIRWAY
• POSITION
• CLEAR AIRWAY-SUCTION MOUTH THEN NOSE

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Initial Steps for Neonatal Resuscitation in
Delivery Room CONT.

• B-BREATHING ADEQUACY
• 1.TACTILE STIMULATION
• slapping or flicking the soles of the feet
• rubbing the back gently
• Do not waste time continuing tactile stimulation
  if there is no response after 10 - 15 seconds.
• 2.FREE FLOW OXYGEN 3.PPV

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Initial Steps for Neonatal Resuscitation in
Delivery Room CONT.

• C-CARDIOVASCULAR RESUSCITATION
• D-DRUG
• -DIAGNOSIS
• E-ENVIRONMENT
• -EXTENDED CARE

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Resuscitation in the delivery room
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PPV

• 1.INDICATION FOR PPV
• APNEA OR GASPING
• HR lt 100 bpm
• CENTRAL CYANOSIS
• 2.BAG-Self inflating vs. flow dependent bag
• 3. Rate 40-60 bpm
• 4. Pressure used
• a.  Initial breath after delivery 30-40 cm
  H2O       b.  Normal delivery 15-20 cm
  H2O       c.  Diseased Lungs 20-40 cm H2O

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PPV CONT.

• 5. Technique/Trouble shooting problems of Bag
  mask ventilation
• a. Check for a good seal     b. Check for a
  patent airway      c. Are you using enough
  pressure ?
• 6.Checking for chest movement
• check mask position
• head position-hyperflexion or hyperextention
• secretion obstruction
• slighly open infant mount
• checking for pressure

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Chest compression

• 1. Indications 
• If after 15-30 seconds of positive pressure
  ventilation with 100 FIO2 the heart rate is
• a. below 60 bpm b.between 60-80 bpm and not
  increasing
• 2. Technique a. 1 fingers breadth below nipple
  line, using 2 fingers        b. 1/2 to 3/4
  compression depth        c. accompanied by
  ventilations, ratio is 31

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METHOD
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ENDOTRACHEAL TUBE INTUBATION

• 1.Indications for intubation
• a.  Prolonged bag and mask ventilation
        b.  Bag and mask is ineffective       c.
  Tracheal suctioning
• 2.Tube size
• Tube size Weight Gestational Age
  (ID mm) (gm) (weeks)
• 2.5 lt1000 lt28
• 3.0 1000-2000 28-34
• 3.5 2000-3000 34-38
• 3.5-4.0 gt3000 gt38

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MEDITATION

• 1.Indication
• HR lt 80 bpm despite 100 O2 and chest compression
  30 sec
• No heart rate

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• Drug
• -adrenaline
• -volume expander
• -NaHCO3
• -Dopamine
• -Naloxone hydrochloride

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Drug dosage
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Drug dosage cont.
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??????????????????????????

• 1.inadequate ventilation missplaced
  ETT,inadequate pressure,air leak syndrome
• 2.Shoke asphyxia,hypovolumic,septic
• 3.Congenital anomalies pulmonary
  hypoplasia,severe cardiac disease

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• THE END
• Thank you