newborn resuscitation belen amparo e. velasco, m.d
TRANSCRIPT
NEWBORN NEWBORN RESUSCITATIONRESUSCITATION
Belen Amparo E. Velasco, M.D.Belen Amparo E. Velasco, M.D.
TEMPERATURE (warm and dry)
ABC’s AIRWAY (position and suction) BREATHING (stimulate to cry) CIRCULATION (heart rate and
color
ASSESS AND SUPPORT
INVERTED PYRAMIDIn NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
ChestCompression
Medications
PREPARATION
ADVANCED PREPARATION
IMMEDIATE PREPARATION
ADVANCED PREPARATION
OBSTETRICAL TRAY
NB RESUSCITATION TRAY
RADIANT WARMER/DROPLIGHT
NB RESUSCITATION EQUIPMENT
Bulb syringe Endotracheal tube (2.5, 3.0, 3.5) and stylets Face masks and ambubag Feeding tubes Gowns, gloves, goggles Heat source Laryngoscope handles and blades Meconium aspirator Medications and fluids Sterile UC set Suction with manometer/catheters Syringes (1, 3, 10 and 20 ml) Warmed blankets
IMMEDIATE PREPARATION
BASED ON RESUSCITATION
-ORIENTED HISTORY
VERIFICATION OF AIRWAYPATENCY AND PLACEMENT OF VASCULAR CATHETERS
RESUSCITATION-ORIENTED HISTORY
MECONIUM STAINING
PREMATURITY
TWIN PREGNANCY
NARCOTICS ADMINISTRATION TO MOTHER
FACTORS ASSOCIATED WITH INCREASED RISK FOR
NEONATAL DEPRESSION
ANTEPARTUM MATERNAL FACTORS
INTRAPARTUM MATERNAL OR FETAL FACTORS
ANTEPARTUM MATERNAL FACTORS
Maternal age > 35 or < 18 Chronic and pregnancy-induced HPN
Diabetes Hemorrhage Drug therapy (Mg, lithium,
adrenergic-blockers Substance abuse Previous abortion No prenatal care Anemia or isoimmunization
ANTEPARTUM MATERNAL FACTORS
Maternal illness (CV, thyroid, neurologic)
Multifetal gestation Small fetus for maternal dates Post-term fetus Preterm labor or PROM Immature pulmonary studies Oligohydramnios Diminished fetal activity Fetal malformation by UTZ
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INTRAPARTUM MATERNALOR FETAL FACTORS
Breech or other abnormal presentation Infection Prolonged labor Prolonged rupture of membranes Prolapsed cord Maternal sedation Operative delivery Meconium-stained AF Indices of fetal distress
UNIVERSALPRECAUTIONS
GLOVES AND OTHER APPROPRIATEPROTECTIVE BARRIERS (gowns and goggles)
SUCTION EQUIPMENT SHOULDALWAYS BE AVAILABLE
INVERTED PYRAMIDIn NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
ChestCompression
Medications
INITIAL STEPS OF RESUSCITATION
(20 seconds)
PREVENTION OF HEAT LOSS
PROPER POSITIONING
SUCTIONING
TACTILE STIMULATION
TEMPERATUREREGULATION
HEAT LOSS MAY BE PREVENTED BY
REMOVING WET LINENS
DRYING THE BABY
PLACING INFANT UNDERPREHEATED LAMP/RADIANTWARMER
TEMPERATUREREGULATION
ALTERNATIVE METHODS OF WARMING:
WARM BLANKETS/TOWELS
WARM MATTRESSES
AIRWAY POSITIONING
PLACEMENT ON BACK OR SIDE WITH NECK IN NEUTRAL POSITION
SHOULDER ROLL (3/4 OR 1 inch) to EXTEND NECK SLIGHLY
AIRWAY SUCTIONING
IF MECONIUM-STAINED, TRACHEAL SUCTIONING
BULB SYRINGE SHOULD BE ADEQUATE
IF NOT MECONIUM-STAINED, SUCTION MOUTH FIRST THEN NOSTRILS
AIRWAY SUCTIONING
MAY USE MECHANICAL SUCTIONWITH 8F OR 10F SUCTION CATHETERS AT NEGATIVE PRESSURE NOT TO EXCEED -100mmHg FOR NO LONGERTHAN 3 to 5 seconds PER ATTEMPT
TACTILE STIMULATION
SLAPPING OR FLICKING THE SOLES
GENTLE RUBBING OF THE BACK
ASSESSMENT
RESPIRATORY EFFORT
HEART RATE
COLOR
INVERTED PYRAMIDIn NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
ChestCompression
Medications
OXYGEN
100% OXYGEN SHOULD BE USED
PREFERABLY WARMED AND HUMIDIFIED
FREE-FLOW O2 BY O2 HOODOR BY FACE MASK ATTACHED TOAMBUBAG OR SIMPLE MASK HELD TO FACE WITH 5L/min O2 FLOW
INVERTED PYRAMIDIn NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
ChestCompression
Medications
POSITIVE-PRESSUREVENTILATION
INDICATIONS
APNEA OR GASPING RESPIRATION
HEART RATE LESS THAN 100 bpm
PERSISTENT CENTRAL CYANOSIS 100% OXYGEN
POSITIVE-PRESSUREVENTILATION
• USUALLY PROVIDED WITH BAG AND MASK
• VENTILATORY RATE of 40-60/min
INVERTED PYRAMIDIn NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
ChestCompression
Medications
CHEST COMPRESSION
INDICATIONS
Persistent bradycardia (60-80/min not increasing) despite 30 seconds of positive pressure ventilation
CHEST COMPRESSION
CHEST COMPRESSION AT A RATIO
with BAGGING OF 1:3 (Total of 120 events)
TWO METHODS:Thumb methodTwo-finger method
INVERTED PYRAMIDIn NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
ChestCompression
Medications
MEDICATIONS
EPINEPHRINE
INDICATIONS
Heart rate of zero
Persistent bradycardia (<60/min) despite 30 seconds of positive pressure ventilation and 30 seconds of chest compression
MEDICATIONS
VOLUME EXPANDERS
INDICATIONS
Acute blood loss
Non-improvement despite adequate resuscitation
MEDICATIONS
SODIUM BICARBONATE
INDICATIONS
Documented metabolic acidosis
Cardiac arrest
MEDICATIONS
NALOXONE
INDICATIONS
Respiratory depression with maternal history of narcotic intake within four hours from the time of delivery