Transcript Neonatal Resuscitation

Neonatal
Resuscitation
ALSO(UK) wish to thank Dr S Richmond for this talk and fully acknowledge
the use of material copyright the northern Neonatal Network, the
Resuscitation Council (UK) and the Newborn Life Support course
Objectives
• Select and properly use equipment for neonatal
resuscitation
• Perform rapid evaluation of the newborn
• Describe resuscitation schemes and algorithms
• Describe the management of meconium
• Describe the management of the early neonatal
period and the most common complications
Stimuli for the first breath
• Cord obstruction
• Cold air
• Physical discomfort
First breaths
Push fluid from airway
& alveoli into pulmonary lymphatics
Establishes
resting lung volume
Sustained (2 second) Inflation Breaths
Breaths
Fetal Lung
Fluid
First
Air
Second
Third
O2
O2
O2
Arterioles Dilate and
Blood Flow Increases
Resuscitation Equipment
YOU CAN SUCCESSFULLY RESUSCITATE WITH THE
FOLLOWING MINIMUM EQUIPMENT & SKILLS:
• Towels to dry and wrap
• Appropriate-sized face mask
• 500ml ventilation bag
• Firm, stable surface (possibly the floor)
• Ability to ventilate appropriately
• Ability to perform cardiac massage
‘Ideal’ Additional Equipment
Clock
Gas supply and blow off valve
Guedel airways
Laryngoscope & Endotracheal tubes
Lighting
Drugs
- Sodium Bicarbonate
- Adrenaline
- Dextrose
- (Volume)
Wide-bore sucker
Scissors and tape
Basic steps in resuscitation
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Dry & cover the baby
Assess the situation
Airway
Breathing - Inflation breaths
Chest compressions
(Drugs)
Initial actions
• Start the clock
• Dry the baby
• Assess
Do you need help ?
Initial assessment
• Colour
• Tone
• Breathing
• Heart rate
Condition – Group 1
• Blue
Pink
• Good tone
• Breathing regularly
• Fast heart rate
Management
• Blue
Pink
• Good tone
• Breathing regularly
• Fast heart rate
Dry and cover
Give to Mum
Condition – Group 2
• Blue
• Moderate tone
• Breathing inadequately
• Slow heart rate
Management
• Blue
• Moderate tone
• Breathing inadequately
• Slow heart rate
Dry and cover
Open the airway
Inflation breaths
Condition – Group 3
• Blue or white
• ‘Floppy’
• Not breathing
• Slow or very slow heart rate
Management
• Blue or white
• ‘Floppy’
• Not breathing
• Slow or very slow heart rate
Dry and cover
Open the airway
Inflation breaths
Re-assess
Do you need help ?
Neonatal Position
for Opening the
Airway – ‘neutral
position’
Correct: Neck
Slightly Extended
Incorrect: Neck
Hyperextension
Incorrect: Neck
Under Extended
Head flexed by large occiput
Head in neutral or ‘sniffing’ position
Jaw falling back – obstructing airway
‘Jaw thrust’ applied – in neutral position
Airway Management
• Open the airway - place the child in the
neutral position
• If necessary, provide jaw thrust
• Give FIVE initial inflation breaths
Inflation breaths
Five breaths,
each sustained for 2-3 seconds
at 30 cms of water pressure
Inflation breaths
• The heart rate will usually respond to
lung inflation
• If there is no heart rate response check
for chest movement
Further resuscitation
• Airway
reassess
• Breathing
reassess - is there a response ?
• Chest compressions
reassess
• Drugs
Chest compressions
• If the chest is not moving, it is not being
inflated
• Check A & B
• Do not start chest compressions until the
chest is being inflated
Reassess
• If the heart rate is slow and not improving
• Consider chest compressions
Chest (cardiac) compressions
“Two-thumb” technique is usually preferred
Chest (cardiac) compressions
• Indicated when HR < 60bpm after 30 seconds of
effective ventilation
• 3:1 compressions:breaths at HR approx 100bpm
(Note: EFFECTIVENESS IS MORE IMPORTANT
THAN RATE!!!)
• Re-evaluate HR every 30 seconds
• Continue cardiac compressions until HR rising and
approx 100bpm (Note: HR USUALLY RESPONDS
RAPIDLY)
Chest (cardiac) compressions
You only need to move oxygenated blood
from the lungs to the coronary arteries
Its not that far and won’t take long!
Reassess
• Has the heart rate improved ?
No
• Re-check airway
• Check chest movement
• Check compressions
Consider drugs
• Sodium bicarbonate
• Adrenaline
• Dextrose
• (Volume - rarely)
Special Cases
• Preterm babies
 care with inflation pressures
• Meconium
 see next slide
• Congenital abnormality
 eg diaphragmatic hernia - may make
resuscitation extremely difficult
• Delivery outside labour ward
 cold babies are more difficult to resuscitate
Meconium
• Suction ONLY IF ‘SOLID’ MECONIUM causing
physical block to ventilation
 use catheter or endotracheal tube with wall suction
• Vigorous infant
 tracheal suction NOT indicated
• Infant with absent/depressed respirations, HR <
100bpm or poor tone
 if bag ventilation is inadequate, intubate with 10F
catheter to clear SOLID meconium below cords
summary neonatal resuscitation
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•
•
•
Dry & cover the baby
Assess the situation
Airway
Breathing - Inflation breaths
Chest compressions
(Drugs)
Neonatal mortality
Causes of neonatal mortality
• Preterm birth
• Asfyxia
• Neonatal sepsis
60-80% of neonatal deaths happen in
low birth weight infants (<2000 gr.)
Preventing neonatal mortality
• All well-responding newborns should be given
to their mother immediately after birth and
start breastfeeding as soon as possible.
• Skin to skin contact with the mother is the best way
of keeping the newborn warm.
• Breastfeeding helps inflate the lungs of the
newborn (and prevents the mother from having
PPH).
• Do not suction the ventricle
Managing preterm births
• If gestational age below 34 weeks the mother
should have corticosteroids:
• Betametazone 12 mg IM twice 24 hours apart
• Reduces risk of perinatal death 68%
• Reduces risk of Respiratory distress syndrome 66%
• Reduces risk of intra-cerebral haemorrhage 54%
Managing preterm or
low birth weight neonates
Kangaroo Mother Care (KMC)
• Early, continuous and
prolonged skin-to-skin contact
between the mother and the
baby
• Exclusive breastfeeding
• Initiated in hospital and can be
continued at home
Kangaroo mother care
Kangaroo mother care
Kangaroo mother care
Breastfeeding:
preferably mothers milk: if not directly then by cup
Kangaroo mother care
Expressing breast milk:
Kangaroo mother care
Expressing breast milk:
Kangaroo mother care
Breastfeeding:
Asfyxia
• Early feeding
• Thermal regulation (KMC / SSC)
• Close observation (at risk for sepsis)
Neonatal sepsis
Risk factors:
• Unhygienic procedures
• Prolonged rupture of membranes >24 hours
• PPROM
• Preterm birth
• Asfyxia
Neonatal sepsis
Signs:
• Unable to breastfeed
• Lethargic or unconscious
• Fast breathing
• Severe chest indrawing
• Grunting
• Fever
• Hypothermia
• Umbilical discharge and redness of surrounding skin
Neonatal sepsis
Treatment:
Early feeding
Antibiotics:
• Ampicillin (or penicillin) 25 mg/kg. IV each 6 hours
• Gentamycin 3 mg/kg IV each 12 hours
• Consider antimalarial treatment
Close observation