Neonatal Resuscitation Part II

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Neonatal ResuscitationPart II

• Mary P. Martinasek, BS, RRT
• Director of Clinical Education
• Hillsborough Community College

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Positive Pressure Ventilation

• Self inflating vs. flow inflating bags
• Flow setting
• Initial Breath pressure
• Subsequent breaths
• Evaluation of adequate PPV
• Oh Gee (OG)!! Two minutes of PPV
• have passed

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Indications for PPV

• Apnea
• Gasping/ineffective respirations
• Spontaneous respirations with HR less than 100
  bpm
• Initial Rate
• Accessories to aide in PPV

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Scenario

• You are in the delivery room bagging a 28 week
  infant via ET tube. The infants HR 80, RR 0
  and Sats are reading 75. What might be the
  problem?

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• Growth and Development
•                                               
  28 Weeks Gestation
• Brain-wave patterns resemble those of a full term
  baby.
• Another person can hear a heartbeat by listening
  to the pregnant womans abdomen.
• There is a good chance of survival if birth
  occurs at this stage of development.
• The weight is about 2 to 2 1/4 pounds.
• The length is about 10 to 13 inches.

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Heart Rate

• When do we evaluate the HR in a resuscitation?
• Locations for pulse check
• If HR is gt100 what do we evaluate next?
• Chest compressions
• Rate
• Methods
• depth

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Intubation

• Indications
• Prolonged PPV
• Bag mask ventilations ineffective
• Thick meconium in infant
• CDH (Congenital diaphragmatic hernia)

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Intubation

• ET tube sizes
• Why uncuffed?
• Stylets
• Blades

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Suggested ET tube sizes
Tube size Tip to lip Infant wt. Gest. age
2.5 6.5- 7.0 cm lt1000 g lt28
3.0 7-8 cm 1000-2000 g 28-34
3.5 8-9 cm 2000-3000 g 34-38
3.5-4.0 gt9 cm gt3000 g gt38
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Medications

• Stimulate the heart
• Increase tissue perfusion
• Restore acid base balance
• Bronchodilation
• Surfactant replacement

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Epinephrine

• Sympathomimetic
• ? HR and peripheral vasoconstriction
• Dose
• 0.1 0.3 mls of 110,000 (IV)
• 0.1 0.3 mls of 11000 (ET)

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Medications Tissue perfusion

• Volume Expanders
• 5 albumin
• Lactated Ringers
• Normal saline
• Dose 10 mls per kg

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Medications restore acid base balance

• Sodium Bicarbonate
• Dose 0.5 meq per ml (4.2 soln) IV
• Bicarbonate Hydrogen CO2

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Other Medications

• Narcan (Naloxone hydrochloride)
• Indicated in severe respiratory depression and a
  confirmed history of maternal narcotic
  administration within the previous 4 hours
• Dose
• 0.1 ml per kg (ET)

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ET tube medications

• Lidocaine
• Atropine
• Narcan
• Epinephrine

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Other routes of medication administration

• Intravenous
• Endotracheal
• Subcutaneous
• Umbilical arterial catheter
• Umbilical venous catheter

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Apgar Score

• Conveys information about the response to
  resuscitation
• Assessed at 1 and 5 minutes
• Appearance
• Pulse
• Grimace
• Activity
• Respiratory effort

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Apgar Score Table
Sign 0 1 2
HR absent Slow (lt100) gt100
RR absent Slow irregular Good, crying
Muscle Tone limp Some flexion Active motion
Irritability (reflex) No response grimace Cough Sneeze Cry
Color blue Pink centrally Blue peripherally Completely pink
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Serum Glucose

• Intrauterine needs placenta
• Term infant 3-5 times adult stores of glycogen
• Other energy source
• Causes of ? glycogen stores

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Hypoglycemia

• Blood glucose concentration less than 35mg/dl in
  term infants and less than 25 mg/dl in preterm
  infants
• Treatment
• Clinical signs
• Apnea / Tachycardia
• Cyanosis
• Jitteriness
• Seizures
• Irritability

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Umbilical catheters

• 3.5 catheter for infants less than 1250 grams
• 5.0 catheter for infants greater than 1250 grams
• Sterile procedure
• UAC vs. UVC identification on X-ray
• uses
• Complications

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