Resuscitation of Babies Born Preterm

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Resuscitation of Babies Born Preterm
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Objectives

• The risk factors associated with being preterm
• The additional resource needed for preterm
  delivery
• Strategies to maintain preterm babys body
  temperature
• Managing oxygen in premature baby
• How to assist ventilation in PT baby with
  breathing difficulty
• Ways to decrease chances of brain injury
• Special precautions to take after resuscitating
  PT baby

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Why are Premature Babies at Higher Risk

• Thin skin, large surface area and decreased body
  fat
• More heat loss
• Immature tissues more easily damaged by excessive
  oxygen
• Weak muscles may make it difficult to breathe
• Drive to breathe may be less
• Lungs may be immature and surfactant deficient
• Immature immune system More likely to get
  infections
• Fragile capillaries in brain IVH
• Small blood volume Hypvolemic effects of blood
  loss

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Additional Resources

• Additional Trained personnel including someone
  skilled in endotracheal intubation
• Additional means of maintaining temperature
• Increase temperature in Delivery room
• Preheat radiant warmer
• Reclosable Polythene bag
• Transport Incubator

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Additional Resources

• Oxygen source capable of delivering 21 100
  oxygen
• Compressed air source
• Oxygen blender
• Pulse oximeter

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How do you Keep the Baby Warm

• Rare cases of Overheating have been described
  with use of plastic-bag technique

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How do you Keep the Baby Warm

• Rare cases of Overheating have been described
  with use of plastic-bag technique

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How Much Oxygen to use

• Hyperoxic re-perfusion injury
• Use Blenders esp if lt 32 weeks
• Start between 21 and 100. Monitor with
  pulse-oximeter
• During first few minutes SpO2 of 70-80 may be
  acceptable, as long as HR and SpO2 are increasing
• If SpO2 are lt 85 and not increasing, increase
  oxygen conc.
• If HR is not increasing rapidly, take care of
  ventilation and use 100 oxygen

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How do Assist Ventilation

• Consider giving CPAP 4 to 6 cm H2O
• Use the lowest Inflation pressure necessary to
  achieve an adequate response
• Consider giving Surfactant if baby is
  significantly Preterm lt 30 weeks

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How do Assist Ventilation

• CPAP cannot be delivered by self-inflating bag

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How to Decrease Chances of Brain Injury

• Handle the baby gently
• Avoid placing the baby in a head-down position
• Avoid delivering excessive positive pressure of
  CPAP
• Pneumothorax or Decreased venous return IVH
• Use oximeter or blood gases to adjust ventilation
  and oxygen concentration
• Do not give rapid infusions avoid hypertonic
  solutions

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Special Precautions after Resuscitation

• Monitor Blood sugar
• Monitor for apnea and bradycardia
• Give an appropriate amount of oxygen and
  ventilation
• Give feedings slowly and cautiously.
• Use parenteral nutrition
• Increase suspicion for infection