Neonatal Resuscitation

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Neonatal Resuscitation

• Lustily crying Active Newborn Baby
• Is A Delight to the

Mother Obstetrician Pediatrician
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Neonatal Resuscitation

• Ventilation of the babys lungs is the
  most important
  and effective Action in Neonatal Resuscitation

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Neonatal Resuscitation
Give a Breath Save a Life !
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Neonatal Resuscitation

• Objectives Lesson 1
• Changes in physiology that occur when a baby is
  born
• Sequence of steps to follow during resuscitation
• Risk factors that can help predict which babies
  require resuscitation
• Equipment and personnel needed to resuscitate a
  newborn

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Why Learn Resuscitation

• Birth asphyxia - 19 ( 5 million) of all neonatal
  deaths every year (WHO 1995)
• By appropriate resuscitation Outcome of
  thousands of newborns may improve
• 10 of all babies require resuscitation 1 need
  extensive resuscitative measures

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Neonatal Resuscitation Program

• Asphyxia as-fikse-ah a Greek word
• Stopping of Pulse
• a condition due to lack of oxygen in respired
  air, resulting in impending or actual cessation
  of apparent life
• Asphyxia is the most likely complication which
  can occur at the time of birth

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Neonatal Resuscitation Program

• resuscitate - Latin word - To arouse again
• Skillful resuscitation of the asphyxiated
  newborn can prevent brain damage and minimize
  subsequent Neonatal morbidity

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ABCs of resuscitation

• Temperature
• Airway (position and clear)
• Breathing (stimulate to breathe)
• Circulation (assess heart rate and color)
• Drugs (Medications)

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Need For Resuscitation
Give Supplemental Oxygen, as necessary
Assist ventilation with positive pressure
Intubate the trachea
Provide chest compressions
Administer medications
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Oxygenation before birth

• Oxygen for fetus from mothers blood
• Small fraction of fetal blood passes through the
  lungs
• Fetal alveoli filled with fluid and vessels
  constricted
• Blood flows primarily through ductus arteriosus
  into the aorta

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Fluid filled alveoli and constricted blood
vessels in the lungs before birth
Constricted vessels before birth
Fluid in alveoli
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Shunting of blood thru ductus away from Lungs
before birth
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What normally happens at birth

• Three major changes occur
• The Fluid in the alveoli is absorbed
• The umbilical arteries and vein constrict and are
  clamped
• Removes low-resistance placental circuit
• Increase systemic blood pressure
• Blood vessels in the lung tissue relax
• Decrease resistance to blood flow

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Changes at birth

• Fluid in the alveoli absorbed and replaced by air

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(No Transcript)
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Cessation of Shunt thru Ductus after birth as
blood preferentially flows through lungs
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What can go wrong during Transition?

• Breaths not forceful to remove alveolar
  fluid
• or
• Foreign material blocks air entry oxygen not
  available
• Excessive blood loss/poor cardiac contractility
  systemic hypotension
• Hypoxia constriction of pulmonary arterioles
  tissue oxygen deprivation (PPHN)

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Response of the baby to an interruption in normal
transition

• Poor muscle tone due to insufficient oxygen
  supply to brain, muscles and other organs
• Depression of respiratory drive from insufficient
  oxygen supply to the brain
• Bradycardia
• Insufficient delivery of oxygen to heart, muscle
  or brain stem
• Low Blood pressure
• Poor myocardial contractility or blood loss
• Tachypnea from failure to absorb lung fluid
• Cyanosis from insufficient oxygen in blood

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In utero or perinatal compromise

• Respiration first to cease after oxygen
  deprivation
• Primary apnea after initial period of rapid
  attempts to breathe responds to stimulation
• Secondary apnea, if oxygen deprivation continues
  requires positive pressure ventilation

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Physiology of asphyxia - Apnea
Rapid breathing
Irregular Gasps
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Physiology of asphyxia - Apnea

• Exposure to Oxygen and stimulation during period
  of primary apnea in most cases will induce
  respiration
• With the onset of Secondary apnea
• HR, BP and pO2 continue to fall farther farther
  
• Infant in this stage is unresponsive to
  stimulation and artificial respiration with
  oxygen must begin at once

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Physiology of asphyxia - Apnea

• In secondary apnea longer you delay starting of
  ventilation longer it takes for spontaneous
  respiration to develop
• Fetus may go from primary to secondary apnea
  in-utero
• Baby born apneic at birth - is assumed to be in
  SECONDARY APNEA

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Sequence of Physiological Events in Animal Models
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Airway

• Duration30 sec

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Breathing

• Duration30 sec

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Circulation

• Duration30 sec

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Drugs

• Epinephrine
• If HR remains lt 60 bpm, continue chest
  compressions and PPV
• When heart rate gt60 bpm stop chest compression
• When heart rate gt100 bpm and baby breathing stop
  ventilation

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Apgar score and resuscitation

• Resuscitation initiated before score assigned
• Not used to determine
• Need for resuscitation
• Steps to be taken and when to resuscitate
• Three signs for evaluation (Evaluated
  simultaneously)
• Respiration
• Heart rate
• Color

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How to prioritize action
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Preterm babies resuscitation

• Some special characteristics in preterm babies
• Surfactant deficiency Lungs more difficult to
  ventilate
• Thin skin/ large surface area to body mass ratio/
  less subcutaneous fat more likely to lose heat
• More prone to infections
• Increased risk of intracranial bleed during stress

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Being Prepared for Resuscitation

• Anticipation for need for resuscitation
• Adequate preparation of both
• Equipment
• Personnel
• Anticipation
• May come as a surprise
• Most episodes can be anticipated
• Antepartum Factors
• Intrapartum Factors

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Being Prepared for Resuscitation

• Adequate preparation
• Trained Personnel At least two
• Equipment
• A radiant warmer Heated and ready to use
• All resuscitation equipment immediately available
  and in working order

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Personnel at delivery

• At every delivery one person with skills to
  perform complete resuscitation must be present
• High risk cases Two or more persons required
• Multiple births Separate team for each baby

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Observational Care
Give Supplementary Oxygen

• Provide positive pressure ventilation ?

Post resuscitation Care

• Provide positive pressure ventilation ?
• Administer Chest Compressions

? Endotracheal intubation may be
considered at several steps
Medications, continue PPV, CC
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Equipment and supplies

1. Newborn resuscitation mannequin
2. Radiant warmer
3. Gloves
4. Bulb syringe or suction catheter
5. Stethoscope
6. Shoulder roll
7. Blanket or towel
8. Self or flow inflating bag

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Equipment and supplies

1. Flow meter
2. Masks
3. Method to administer oxygen
4. Laryngoscope and blade
5. Suction catheter
6. Endotracheal tube
7. Meconium aspirator
8. Clock with second hand
9. Mechanical suction and tubing