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Dr. Muhammad Zahoor ul Haq Dr. Muhammad Zahoor ul Haq Assistant Professor of PaediatricsAssistant Professor of Paediatrics
RMC RawalpindiRMC Rawalpindi
Neonatal Neonatal ResuscitationResuscitation
Neonatal Resuscitation Neonatal Resuscitation
• Resuscitation is active Resuscitation is active intervention to establish intervention to establish normal cardio respiratory normal cardio respiratory functionfunction
• 5-10%5-10% require active require active interventionintervention
GoalGoal
• To prevent morbidity & mortality To prevent morbidity & mortality associated associated with hypoxic ischemic with hypoxic ischemic tissue tissue
(brain, heart, kidney) injury(brain, heart, kidney) injury
• Anticipate high risk situationsAnticipate high risk situations
Guideline for neonatal Guideline for neonatal resuscitation resuscitation
Integrated assessment / response Integrated assessment / response approach approach for for initial evaluation of an initial evaluation of an infant infant
- Color - Color - General appearance - General appearance - Risk factor- Risk factor
Fundamental PrinciplesFundamental Principles
- Evaluation of airway- Evaluation of airway
- Establishing effective respiration - Establishing effective respiration
- Establishing adequate circulation- Establishing adequate circulation
Immediate Care Immediate Care - Place under radiant heater - Place under radiant heater
- Dry - Dry
- Position (head down & slightly - Position (head down & slightly extended)extended)
- Clear airway - Clear airway
- Gentle tectile stimulation- Gentle tectile stimulation
Assess Assess - - Infant’s color Infant’s color
- Heart rate - Heart rate
BIRTH
Term gestation?Amniotic fluid clear?Breathing or crying?Good muscle tone?
Routine care. Provide warmth . Clear airway if needed. Dry . Assess color
Provide warmth Position; clear airway*(as necessary)Dry, stimulate, reposition
Evaluate respirations
Heart rate, and color Observational Care
Yes
Approximate
time
Breathing
HR>100
& Pnk
30
S
eco
nd
sThe Fetus and Neonatal Infant
Give supplementary
Oxygen
Provide positive –pressure ventilation
Provide positive pressure ventilation
Administer chest compression
Administer epinephrine and or volume*
Postresuscitation Care
Evaluate respirationsHeart reate, and color
Observational Care
Breathing HR>100
& Pnk
Pink
Apnea or HR <100
Breathing HR>100 but Cyanotic
Persistent Cyanosis
Effective Ventilation HR>100 & pink
HR<60
HR>60
HR<60
B
C
D
30
S
eco
nd
s3
0
Seco
nd
s
BIRTH
Term gestation?Amniotic fluid clear?Breathing or crying?Good muscle tone?
Routine care. Provide warmth . Clear airway if needed. Dry . Assess color
Provide warmth Position; clear airway*(as necessary)Dry, stimulate, reposition
Evaluate respirations
Heart rate, and color Observational Care
Yes
Approximate
time
Breathing HR>
& Pink
30
S
eco
nd
s
The Fetus and Neonatal Infant
Give supplementary
Oxygen
Provide positive –pressure ventilation
Provide positive pressure ventilation
Administer chest compression
Administer epinephrine and or volume*
Breathing HR>100 but Cyanotic Pink
Apnea or HR <100
Postresuscitation Care Persistent Cyanosis
Effective Ventilation HR>100 & pink
HR<60 HR>60
HR<60
A
B
C
D
30
S
eco
nd
s3
0
Seco
nd
s
No
Respiratory EffortRespiratory EffortStepsSteps
Follow ABCsFollow ABCsA-A- Anticepate & establish Anticepate & establish B- B- Initiate Breathing Initiate Breathing C-C- Maintain Circulation Maintain Circulation D-D- DrugsDrugs
If no respiration or heart If no respiration or heart rate below 100/minrate below 100/min
- Give positive pressure with face - Give positive pressure with face maskmask
- Endotracheal intubation - Endotracheal intubation
If heart does not improve If heart does not improve then:then:
- Start chest compression - Start chest compression
- Site - Site
Lower third of sternum Lower third of sternum 3:13:1
If no improvement If no improvement
give epinephrine give epinephrine
Poor response to Poor response to Ventilation Ventilation
- Loosely fitted mask - Loosely fitted mask - Poor position of ETT- Poor position of ETT- Intraesophageal intubation - Intraesophageal intubation - Airway Obstruction - Airway Obstruction - Insufficient pressure- Insufficient pressure- Excess Air in Stomach - Excess Air in Stomach
Administration of Naloxone Administration of Naloxone HydrochlorideHydrochloride
Ind:Ind: - - Respiratory depression Respiratory depression - Mother has H/O narcotic - Mother has H/O narcotic - Drug administration - Drug administration
Dose:- Dose:- 0.1mg/kg ½, intratracheal0.1mg/kg ½, intratracheal
Emergency Volume Emergency Volume Expander Expander
- Isotonic crystalloid solution - Isotonic crystalloid solution 10-20ml/kg10-20ml/kg
- O -ve blood - O -ve blood
Sodium Bicarbonate Sodium Bicarbonate - Indication - Indication
- Documented metabolic - Documented metabolic acidosis acidosis
- Prolong resuscitation- Prolong resuscitation
- Dose- Dose - - 2meq/kg ½2meq/kg ½
Dopamine or Dobutamine Dopamine or Dobutamine Ind:Ind:
- Cardiogenic shock - Cardiogenic shock
- Dose 5-20mg/kg/min- Dose 5-20mg/kg/min
Infusion Epinephrine Infusion Epinephrine Ind:Ind:
- Unresponsive Cardiac shock - Unresponsive Cardiac shock
Dose:Dose:- 0.1-1.0mg/kg/min - 0.1-1.0mg/kg/min
Primary Apnea Primary Apnea →Asphyxia →Reduce →Asphyxia →Reduce Heart rate → apnea Heart rate → apnea
Immediate Intervention Immediate Intervention - Oxygen inhalation - Oxygen inhalation - Tectile stimulation- Tectile stimulation
Secondary Apnea Secondary Apnea - Gasping respiration - Gasping respiration - Bradycardia - Bradycardia - Hypotension - Hypotension - Finally apnea- Finally apnea
Immediate Intervention Immediate Intervention - Positive pressure ventilation - Positive pressure ventilation
Equipment RequiredEquipment Required- Resuscitation table - Resuscitation table - Sterile Linen - Sterile Linen - Suction apparatus ( Catheter 5, 6, 8)- Suction apparatus ( Catheter 5, 6, 8)- Laryngoscope with straight blade - Laryngoscope with straight blade - Ambo bag with face mask- Ambo bag with face mask- Endotracheal tube - Endotracheal tube - Gloves - Gloves
Medications Medications - Epinephrine 1:10,000- Epinephrine 1:10,000- Naloxone hydrochloride - Naloxone hydrochloride - Volume expander - Volume expander - Soda bicarbonate - Soda bicarbonate - 10% Dextrose water - 10% Dextrose water - Sterile water - Sterile water
Miscellaneous Miscellaneous - Radiant warmer- Radiant warmer- Stethoscope - Stethoscope - Adhesive tape - Adhesive tape - Syringes - Syringes - Butterfly needle - Butterfly needle - Umbilical artery - Umbilical artery - Catheterization tray- Catheterization tray
Indication for Endotracheal Indication for Endotracheal tube tube
Intubation Intubation - Ineffective bag & mask - Ineffective bag & mask
ventilation ventilation - Prolong PPV required - Prolong PPV required - Suspicion of diaphragmatic - Suspicion of diaphragmatic
hernia hernia -Preterm infant-Preterm infant-Meconium aspiration-Meconium aspiration
Stop ResuscitationStop Resuscitation
If no respiratory & cardiac If no respiratory & cardiac activity after 20 min of activity after 20 min of resuscitationresuscitation
Fixed pupilFixed pupil