Neonatal Resuscitation Joseph Gilhooly, MD Doernbecher Children’s Hospital NRP 2001 Resuscitation Algorithm: 2001 Why we need to resuscitate: pH 7.30 pH 7.00 pH 6.80
Download ReportTranscript Neonatal Resuscitation Joseph Gilhooly, MD Doernbecher Children’s Hospital NRP 2001 Resuscitation Algorithm: 2001 Why we need to resuscitate: pH 7.30 pH 7.00 pH 6.80
Neonatal Resuscitation Joseph Gilhooly, MD Doernbecher Children’s Hospital NRP 2001 Resuscitation Algorithm: 2001 Why we need to resuscitate: pH 7.30 pH 7.00 pH 6.80 How often do we use our resuscitation skills? Suction Equipment Warmer & Blankets Bag, Mask, & Oxygen Laryngoscope and ETT Tube Universal Precautions Assessment: Then • • • • • Appearance Pulse Grimace Activity Respirations Assessment: Now Physiologic Parameters (Apgar’s best) • Breathing • Heart Rate • Color Questions to ask yourself • • • • • Clear of Meconium? Breathing or Crying? Good Muscle tone? Color Pink? Term Gestation? Initial Management: For all deliveries • • • • Provide warmth Position and Clear Airway Dry Give Oxygen (as necessary) Providing Warmth: The cycle of hypothermia Acidosis Anaerobic metabolism Pulmonary Vasoconstriction Pulmonary Hypertension Tissue hypoxia Hypoxemia Right to left shunting Positioning: Sniffing The “Trusty” Bulb Syringe Clear of Meconium? Color pink? Pulse Oximetry: Resuscitation monitor • Not affected by acrocyanosis • Be patient and get a reading • If baby in shock, get central IV access Breathing or Crying? • Indications for PPV – Apnea or gasping – Heart rate <100 even if breathing – Persistent central cyanosis (saturation <90%) despite 100% free-flow oxygen Self-Inflating Bag O2 Reservoir Pressure manometer attaches PEEP valve port 200-750ml Bag size Neopuff • CPAP • Pressure limited ventilation with PEEP • Blended oxygen • Eliminates variability associated with bag ventilation Masks Smallest sizes are for preterm infants • Make sure the airway is clear • Lift the baby’s jaw into the mask • Keep the mouth slightly open Rate 40-60 Indications for Intubation • Meconium and baby is not vigorous • PPV by bag-mask does not result in good chest rise • PPV needed beyond a few minutes • Chest compressions necessary • Route to administer epinephrine • Special indications: Prematurity, CDH Miller 0 Miller 1 3.5 3.0 >2000 gm 1000-2000 gm 2.5 <1000 gm Stylet Intubation Technique Lip reference mark: (6 + weight in kilos) cm 9-10 cm at the lip for this term infant Indications for Compressions • Heart rate <60 bpm after 30sec of PPV • Coordinate with ventilation – 4 events in 2 seconds – 90 compressions and 30 breaths per minute One and Two and Three and Breathe 2 seconds Compressions 2 thumb technique preferred Medications: Epinephrine • Indication: Heart rate <60 after 30 sec of coordinated ventilation and compressions • 1:10,000 (0.1mg/ml) • Route: ETT or IV • 0.1-0.3 ml/kg – 1ml Term – 0.5ml Preterm – 0.25ml Extreme preterm Extended Algorithm • Endotracheal Intubation if not already accomplished • Establish IV access with UVC • Stat CXR • Discontinue efforts if no heart rate after 15 minutes IV Access: “Low” UVC Volume • Indication: No response to resuscitation and evidence of blood loss • Normal Saline – Ringers or Blood as alternatives • 10 ml/kg, may repeat • Route: IV (Umbilical vein) Sodium Bicarbonate • Indication: Documented or assumed metabolic acidosis • Concentration: 4.2% NaHCO3 (0.5meq/ml) • Dose: 2meq/kg • Route: IV (Umbilical vein) Naloxone (Narcan) • Indication: Severe respiratory depression after PPV has restored a normal HR and color and… – History of maternal narcotic administration within the past 4 hours • Dose: 0.1mg/kg of 1mg/ml solution • Route: ETT, IV, IM, SQ Hypoglycemia • Blood Glucose <45-60 –5cc/k D10W –Route IV