9 10 2010 0-42-42 r neonatal-resuscitation

8/8/2019 9 10 2010 0-42-42 R Neonatal-Resuscitation

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Pacific EmOC Program

Neonatal Resuscitation

REFERENCES:

ILCOR Guidelines 2005

WHO Regional Credentialing Program


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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


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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


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Antepartum Risks

Maternal diabetes

Chronic maternal illness

Cardiovascular

Thyroid

Neurological

Pulmonary

renal

Pre eclampsia

Maternal infection

Polyhydramnios

Oligohydramnios

Premature rupture ofmembranes

IUGR/preterm

Fetal malformation

Maternal substance abuse

No antenatal care

Post term gestation

Multiple gestation

Anaemia

Age 35


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Intrapartum Risks

Emergency CS

Instrumental delivery

Abnormal position

Premature labourPrecipitous labour

Chorioamnionitis

Prolonged rupture ofmembranes

Prolonged labour > 24 hrs

Prolonged 2nd stage oflabour

Fetal bradycardia

Non-reassuring fetal heartrate pattern

General anaesthesia

Narcotics administeredwithin 4 hours of delivery

Meconium stained liquor

Prolapsed cordAbruptio placentae

Placenta previa


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Fetal asphyxia

Primary apnoea

Apnoeic

Blue Heart rate

Resuscitate easily

Secondary

apnoeic

White, floppy Heart rate

Blood pressure

Require active

resuscitation eg IPPVto survive


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Always assume infant has secondary

Apnoea & commence Resuscitation


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Equipment Needed for Resuscitation

Radiant warmer

Warm towel and blankets

Resuscitation bag andmask

Self inflating bag

Anaesthetic bag

Endotracheal tubes

Laryngoscope

Stethoscope

Oxygen source and

tubing

Suction source andtubing

Drugs and fluids

Syringes, needles,

cannulae, IV lines

+/-Umbilical lines


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ILCOR Guidelines for

Neonatal Resuscitation

2005


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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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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


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Breathing

Assessment of respiratory effort and colourIndications for oxygen administration

Cyanosis

Respiratory distress

Give free flowing oxygen 5L/min


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Breathing: Indications for

positive pressure ventilation

Apnoea

Gasping respiration

HR < 100 bpm

Persistent central

cyanosis despite 100%

O2

40-60 breaths/min

No response


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Circulation

Assessment of heart rate and responseto previous measures

Umbilical arteries

Apex beat

Auscultation


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Chest

Compressions

HR < 60 bpm despite

adequate vent with

100% O2 for 30seconds

2 techniques

2 thumb (preferred)

2 finger

3:1 ratio

1/3 of AP diameter


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Steps in resuscitation - ABCDE

Drugs

AdrenalineVolume Expanders

Naloxone


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Adrenaline

HR < 60 bpm after 30 seconds ofadequate ventilation and chest

compressions0.1 - 0.3 mL kg of 1:10,000

Give via ETT, UVC, IV

Repeat dose if no response after 60seconds


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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, IVIf haemorrhagic shock is suspected give whole

blood or packed red cells


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Naloxone

Narcotic antagonist

Inadequate spontaneous respiratory effort

Mothers who received narcotics within 4hrs of delivery

0.1mg/kg of a 0.4 mg/mL solution

ETT, IV, UVC, IM, SC

Monitor babys respirations for furtherrespiratory depression


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Steps in resuscitation- ABCDE

Environment

Reduce draughts

Shut doors and

windows

Turn on radiant

warmer

Warm blankets/bunnyrugs/hat/plastic wrap

for pre terms


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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

9 10 2010 0-42-42 r neonatal-resuscitation

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