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 diabetesChronic maternal illness Cardiovascular Thyroid Neurological Pulmonary renal

Pre eclampsiaMaternal infectionPolyhydramniosOligohydramnios

Premature rupture of membranesIUGR/pretermFetal malformationMaternal substance abuseNo antenatal carePost term gestationMultiple gestationAnaemiaAge <16 or > 35

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Intrapartum Risks

Emergency CSInstrumental deliveryAbnormal positionPremature labourPrecipitous labourChorioamnionitisProlonged rupture of membranesProlonged labour > 24 hrsProlonged 2nd stage of labour

Fetal bradycardiaNon-reassuring fetal heart rate patternGeneral anaesthesiaNarcotics administered within 4 hours of deliveryMeconium stained liquorProlapsed cordAbruptio placentaePlacenta 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 IPPV to 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 and mask Self inflating bag Anaesthetic bag

Endotracheal tubes

Laryngoscope

Stethoscope

Oxygen source and tubing

Suction source and tubing

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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Steps in Resuscitation - ABCDE

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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Steps in Resuscitation - ABCDE

Breathing

Assessment of respiratory effort and colour

Indications 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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Steps in Resuscitation - ABCDE

Circulation

Assessment of heart rate and response to previous measures Umbilical arteries Apex beat Auscultation

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Chest Compressions

HR < 60 bpm despite adequate vent with 100% O2 for 30 seconds

2 techniques 2 thumb (preferred) 2 finger 3:1 ratio 1/3 of AP diameter

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Steps in resuscitation - ABCDE

Drugs

Adrenaline

Volume Expanders

Naloxone

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Adrenaline

HR < 60 bpm after 30 seconds of adequate ventilation and chest compressions0.1 - 0.3 mL kg of 1:10,000Give via ETT, UVC, IVRepeat dose if no response after 60 seconds

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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, IV

If haemorrhagic shock is suspected give whole blood or packed red cells

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Naloxone

Narcotic antagonistInadequate spontaneous respiratory effortMothers who received narcotics within 4 hrs of delivery0.1mg/kg of a 0.4 mg/mL solution ETT, IV, UVC, IM, SCMonitor baby’s respirations for further respiratory depression

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Steps in resuscitation- ABCDE

Environment

Reduce draughts Shut doors and

windows Turn on radiant

warmer Warm blankets/bunny

rugs/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