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Newborn resuscitation programme(NRP)Renu Singh
Burden of the problemBirth asphyxia23% of the 1 million neonatal deaths in IndiaLong term neurological complicationsDeathNNR (Neonatal resuscitation) :simple, inexpensive, cost effective methodProblem: NNR often not initiated, incorrect use of methods
The Golden minuteThe first minute after birthAnxiety for parents, health providersPeriod of transition from intrauterine to extra uterine lifeMajor: No/minimal assistance10%: assistance to begin breathing at birth1%: extensive resuscitative measuresFirst Golden Minute Project: skill based training
Successful NNR: factorsAnticipation: call a skilled personnelAdequate preparationAccurate evaluation, algorithm basedPrompt initiation of support
Resuscitation: initial stepsProvide warmthHead position sniffing positionClearing the airwayDrying the babyTactile stimulation for breathing
Sniffing positionExtension of neck with help shoulder roll:: to open the airway
Newly born infantSpecifically the Infant at time of birth
(A)Do not require resuscitation(B)Require resuscitation Rapid assessment of 3 charactersTerm gestation?Crying or breathing?Good muscle tone?
Newly born infantTerm gestation?Crying or breathing?Good muscle tone? YES :Do not require resuscitationDrySkin to skin contactCovered with dry linen to maintain temperatureOngoing observation: breathing, color, activity
Newly born infantTerm gestation?Crying or breathing?Good muscle tone?NO :require resuscitation; One/more of the following actions in sequenceInitial steps in stabilization(warmth, clear airway, dry, stimulate)VentilationChest compressionsAdministration of epinephrine& /or volume expansion
AAP Algorithm
IAP Algorithm
Targeted SPO2 after birth
1 minute60-65%2 minutes65-70%3 minutes70-75%4 minutes75-80%5 minutes80-85%10 minutes85-90%
Increase in heart rate is the most sensitive indicator of a successful response to each step practiced
PPV: Positive pressure ventilationForm of assisted ventilationNeeded when there is no improvement in HRAlso assess chest wall movementsShould be delivered at rate of 40-60 breaths /min, maintain HR>100 /minDevices: BMV, ET (endotracheal tube),LMA(laryngeal mask airway)
Bag & mask ventilation
Endotracheal tubeInitial endotracheal suctioning of non vigorous meconium stained newbornIf BMV is ineffective/prolongedWhen chest compressions are performed
Endotracheal tube
LMA(Laryngeal mask airway)Fits over laryngeal inletDone when BMV is unsuccessfulWhen tracheal intubation is unsuccessful or not feasible
LMA(Laryngeal mask airway)
Chest compressions
EpinephrineRoute of administration: intravenous(IV),idealRecommended dose: 0.01-0.03 mg/kg per doseDesired concentration: 1:10,000 0.1 mg/ml
Volume expansionSuspected or known blood lossIsotonic crystalloid solutionBloodDose calculation: 10 ml/kg
Post resuscitation careNeeded for those who required PPVAt risk of deteriorationNeed monitoring ,evaluationNICU may be necessary
NNR: nearly always indicatedHigh rate of survivalAcceptable morbidityGA 25 weeksThose with most congenital malformations
NNR?Conditions associated with uncertain prognosisSurvival borderline
Parental desires concerning initiation of resuscitation should be supported
Discontinuing resuscitative effortsNewly born baby with no detectable heart rate, consider stopping NNR if the heart rate remains undetectable for 10 minutes
MCQ1For successful neonatal resuscitation following is/are needed except:AnticipationAdequate preparationSkilled personnelDelayed initiation of support
MCQ1 For successful neonatal resuscitation following is/are needed except:AnticipationAdequate preparationSkilled personnelDelayed initiation of support
MCQ2Following are true in relation to initial steps of neonatal resuscitation exceptProvide warmthTactile stimulationClear airway and intubationDrying the baby
MCQ2Following are true in relation to initial steps of neonatal resuscitation exceptProvide warmthTactile stimulationClear airway and intubationDrying the baby
MCQ3The following is the primary measure of adequate ventilationChest wall movementImprovement in heart ratePink extremitiesSpo2 of 80%
MCQ3The following is the primary measure of adequate ventilationChest wall movementImprovement in heart ratePink extremitiesSpo2 of 80%
MCQ4Endotracheal intubation may be indicated at several points during neonatal resuscitation exceptIf BMV is ineffectiveWhen chest compressions are performedEndotracheal suctioning of vigorous meconium stained newbornsFor special resuscitation circumstances like extremely LBW
MCQ4Endotracheal intubation may be indicated at several points during neonatal resuscitation exceptIf BMV is ineffectiveWhen chest compressions are performedEndotracheal suctioning of vigorous meconium stained newbornsFor special resuscitation circumstances like extremely LBW
MCQ5The recommended compression to ventilation ratio in neonatal resuscitation is 2:13:14:15:1
MCQ5The recommended compression to ventilation ratio in neonatal resuscitation is 2:13:14:15:1
MCQ6The recommended dose(mg/kg per dose) and route of epinephrine in neonatal resuscitation0.01-0.03,IV0.01-0.03,IM0.03-0.05,1V0.05-0.1,IV
MCQ6The recommended dose(mg/kg per dose) and route of epinephrine in neonatal resuscitation is0.01-0.03,IV0.01-0.03,IM0.03-0.05,1V0.05-0.1,IV
MCQ7Recommended method/clinical indicator of confirming ET placement isCondensation in ETChest movementEqual breath sounds on auscultationExhaled C02 Detection
MCQ7Recommended method/clinical indicator of confirming ET placement isCondensation in ETChest movementEqual breath sounds on auscultationExhaled C02 Detection