Neonatal Resuscitation

1
Neonatal Resuscitation

• REFERENCES
• ILCOR Guidelines 2005
• WHO Regional Credentialing Program

2
Objectives

• Identify of infants at risk for asphyxia
• Discuss effects of asphyxia
• Describe Resuscitation of newborn
• Equipment
• Bag and mask ventilation
• Cardiac compressions
• Post resuscitation care

3
How many infants might require active
resuscitation?

• 10 require some degree of active resuscitation
• For up to 50 of this group there are no risk
  factors
• Staff attending deliveries may be faced with an
  unexpectedly flat infant

4
Antepartum Risks

• Maternal diabetes
• Chronic maternal illness
• Cardiovascular
• Thyroid
• Neurological
• Pulmonary
• renal
• Pre eclampsia
• Maternal infection
• Polyhydramnios
• Oligohydramnios

• Premature rupture of membranes
• IUGR/preterm
• Fetal malformation
• Maternal substance abuse
• No antenatal care
• Post term gestation
• Multiple gestation
• Anaemia
• Age lt16 or gt 35

5
Intrapartum Risks

• Emergency CS
• Instrumental delivery
• Abnormal position
• Premature labour
• Precipitous labour
• Chorioamnionitis
• Prolonged rupture of membranes
• Prolonged labour gt 24 hrs
• Prolonged 2nd stage of labour

• Fetal bradycardia
• Non-reassuring fetal heart rate pattern
• General anaesthesia
• Narcotics administered within 4 hours of delivery
• Meconium stained liquor
• Prolapsed cord
• Abruptio placentae
• Placenta previa

6
Fetal asphyxia

• Primary apnoea
• Apnoeic
• Blue
• Heart rate ?
• Resuscitate easily

• Secondary
• apnoeic
• White, floppy
• Heart rate ?
• Blood pressure
• Require active resuscitation eg IPPV to survive

7
Always assume infant has secondary Apnoea
commence Resuscitation

• 
  

8
Equipment Needed for Resuscitation

• Radiant warmer
• Warm towel and blankets
• Resuscitation bag and mask
• Self inflating bag
• Anaesthetic bag
• Endotracheal tubes
• Laryngoscope
• Stethoscope

• Oxygen source and tubing
• Suction source and tubing
• Drugs and fluids
• Syringes, needles, cannulae, IV lines
• /-Umbilical lines

9
ILCOR Guidelines for Neonatal Resuscitation 2005
10
Steps in Resuscitation - ABCDE

• Warmth and stimulation and assessment for the 1st
  30 seconds
• Use warm cloth
• Replace when wet
• Rapidly assess
• Tone
• Colour
• Respiratory effort

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Steps in Resuscitation - ABCDE

• Airway
• Clear airway if required
• Removal of secretions if present
• Suction mouth and nose (only what you can see)
• No more than 5cms for no longer than 5 secs
• Negative pressure 100 mmHg (5litres)
• DO NOT SUCTION IF AIRWAY IS CLEAR
• Positioning
• Supine or lateral
• Head in neutral or slightly extended position

12
Steps in Resuscitation - ABCDE

• Breathing
• Assessment of respiratory effort and colour
• Indications for oxygen administration
• Cyanosis
• Respiratory distress
• Give free flowing oxygen 5L/min

13
Breathing Indications for positive pressure
ventilation

• Apnoea
• Gasping respiration
• HR lt 100 bpm
• Persistent central cyanosis despite 100 O2
• 40-60 breaths/min
• No response

14
Steps in Resuscitation - ABCDE

• Circulation
• Assessment of heart rate and response to previous
  measures
• Umbilical arteries
• Apex beat
• Auscultation

15
Chest Compressions

• HR lt 60 bpm despite adequate vent with 100 O2
  for 30 seconds
• 2 techniques
• 2 thumb (preferred)
• 2 finger
• 31 ratio
• 1/3 of AP diameter

16
Steps in resuscitation - ABCDE

• Drugs
• Adrenaline
• Volume Expanders
• Naloxone

17
Adrenaline

• HR lt 60 bpm after 30 seconds of adequate
  ventilation and chest compressions
• 0.1 - 0.3 mL kg of 110,000
• Give via ETT, UVC, IV
• Repeat dose if no response after 60 seconds

18
Volume expanders

• Not given routinely
• Useful in hypovolemia
• Suspected where there is a pale tachycardic
  infant
• Normal saline
• 10mL/kg over 5-10 mins
• UVC, IV
• If haemorrhagic shock is suspected give whole
  blood or packed red cells

19
Naloxone

• Narcotic antagonist
• Inadequate spontaneous respiratory effort
• Mothers who received narcotics within 4 hrs of
  delivery
• 0.1mg/kg of a 0.4 mg/mL solution
• ETT, IV, UVC, IM, SC
• Monitor babys respirations for further
  respiratory depression

20
Steps in resuscitation- ABCDE

• Environment
• Reduce draughts
• Shut doors and windows
• Turn on radiant warmer
• Warm blankets/bunny rugs/hat/plastic wrap for pre
  terms

21
Meconium liquor

• ILCOR guidelines 2005 no evidence to suction
  mouth and nose on perineum
• If baby vigorous and crying - normal care
  observation
• If baby not vigorous view cords and suction
  trachea under direct vision with laryngoscope
  mec aspirator or wide bore catheter
• Cease suctioning if return is clear or Heart Rate
  ? 60
• Observe post resuscitation for signs of
  respiratory distress