NEONATAL RESUSCITATION

Dr.(COL) C.G.WILSON
PROFESSOR& H.O.D(PAED)

Dr. K.SATYANARAYANA
CONSULTANT(PAED)

KAMINENI HOSPITALS
PREPARATION FOR
NEONATAL RESUSCITATION
Dr. K.SATYANARAYANA
M.D;
CONSULTANT(PAED)
NEONATAL RESUSCITATION
After delivery most of the babies fall into one of
the 4 groups.

1. Fit and healthy (90-95%)
2. Primary apnoea (5-6%)
Apnoeic and blue
Inadequate breathing
HR : 80 100
3. Terminal apnoea (0.2 0.5%)
pale, limp
apnoeic
HR < 60
4. Dead but resuscitable ( < 0.1%)
Which baby requires resuscitation ?
No respiratory effort at all
Feeble and Inadequate effort
Vigorous respiratory effort but
cyanosed
Apnoeic due to primary muscle and
CNS disorder
* Anticipation and preparation are key
factors in the management of resuscitation.
Identification of the high risk neonate:
1. PiH
2. DM
3. Oligohydramnios / Polyhydramnios
4. Multiple pregnancy
5. Rh incompatability
6. Postdated pregnancy
7. APH
8. Abnormal presentations
9. Maternal infections and disorders
10. Meconium stained liquor
11. Prolonged labour
12. Cord prolapse / shoulder dystocia
FACTORS OTHER THAN B.A.
REQUIRING RESUSCIATION
1. PT
2. Maternal hypocapnia
3. Maternal drugs depressing CNS
4. Sepsis (GBS)
5. Anemia
6. Primary muscle and CNS disorder
7. Congential malformations of the
airway and CNS

PRIMARY APNOEA
Shallow respiration
HR & BP Responds to stimulation
Tone and O2 inhalation
SECONDARY APNOEA
HR & BP Requires resuscitation
Flaccid
Primary apnoea and secondary apnoea may occur
even in utero. Apnoea at birth assume it as
secondary apnoea only.
Secondary apnoea and brain damage.
Asphyxia is defined as combn of hypoxemia,
hypercapnia and metabolic acidosis.
Hypoxemia & acidosis

Constriction of arterioles in lungs

Constriction of the PBF, Perfusion
arterioles of other
organs (brain&heart
spared)

Organ damage Oxygenation of tissues
PREPARATION FOR RESUSCIATATION
Personnel:
1 person skilled in resuscitation should attend
every delivery
2 persons depressed newborn
1 person Intubation & ventilation
2
nd
person Monitor HR & chest compressions
Multiple pregnancy Separate team for each
infant
NEONATAL RESUSCITATION SUPPLIES
AND EQUIPMENT
Suction equipment:
Bulb syringe
Mechanical slow suction (100mm Hg) with
tubing
Suction catheters, 5F or 6F, 8F and 10F or 12F
Meconium aspiration device
Bag-and-mask equipment:
Neonatal resuscitation bag with a pressure-
release valve and / or pressure manometer and
reservoir (the bag must be capable of delivering
90% to 100% oxygen)
Face masks, newborn and premature sizes
(masks with cushioned rim preferred)
Oxygen with flow meter (flow rate up to
10L/min and tubing (including portable oxygen
cylinders)
Intubation equipment:
Laryngoscope with straight blades, No. 0
(preterm) and No.1 (term)
Extra bulbs and batteries for laryngoscope
Endotracheal tubes: 2.5, 3.5, and 4.0mm ID
Styllet (optional)
Scissors
Tape for securing tracheal tube
Laryngeal mask airway (optional)
Umbilical vessel catheterization:
Sterile gloves
Scalpel or scissors
Providone iodine solution
Alcohol sponges
Umbilical tape
Umbilical catheters: 3.5F, 5F
Three-way stopcock
Flushing solution
Miscellaneous:
Gloves and appropriate personal protection
Radiant warmer or other heat source
Firm, padded resuscitation surface
Clock (timer optional)
Warmed linens (at least two per delivery)
Stethoscope
Tape, or inch
Miscellaneous:
Cardiac monitor and electrodes (optional)
and/or pulse oximeter with probe.
Oropharyngeal airways
Syringes 1, 2, 5, 10, 20 and 50mL
Needles- 18, 21 & 25 gauge or puncture device
for needle less system.
Medications:
Administration of drugs is rarely indicated in resuscitation
of the NB infant. However, in rare cases the following
medications are used:
Epinephrine 1:10,000 (0.1mg/mL) Dilute 1ml of 1:1000
solution and keep ready (0.5ml. + 4.5ml NS)
Isotonic crystalloid (normal saline or Ringers lactate) for
volume expansion. (Albumin is no longer recommended). 0-
ve red cells may be used.
Sodium bicarbonate dilute 7.5% solution 1:1 with DW to
get approximate concentration
Naloxone hydrochloride 0.4mg/mL 1-mL ampoules; or 1.0
mg/mL 2-mL ampoules
NEONATAL RESUSCITATION
PROTOCOL

STEPS OF RESUSCITATION

Dr(col) C.G.WILSON
PROFESSOR& H.O.D(PAED)
STEPS OF RESUSCITATION
ON YOUR MARCH.GET SET

PREVENTION OF HEAT LOSS
PROVIDE WARMTH
AIRWAY CLEARING & CLEANING
INITIATION OF BREATHING
EVALUATION
PREVENTION OF HEAT LOSS
& PROVIDE WARMTH

DRYING PREWARMED TOWEL
REMOVE WET TOWEL
RADIANT WARMER
EUTHERMIC ATMOSPHERE
AIRWAY MANAGEMENT

EXCESSIVE SECRETIONS &
M S A F BEFORE DRYING

POSITION - ON BACK FLAT
HEAD SLIGHT EXTENSION
& ONESIDE
TOWEL - SHOULDER BLADE
AIRWAY CLEARING
BULB SYRINGE
De Lee MUCUS SUCKER
MECHANICAL 100mm Hg
INITIATION OF BREATHING
TACTILE STIMULATION
HARMFUL ACTIONS CONSEQUENCES
1. SLAPPING BACK BRUISING

2. SQUEEZING RIB CAGE # PNEUMO


3. FORCING THIGHS ONTO RUPUTURE OF
ABDOMEN LIVER, SPLEEN

4. HOT / COLD COMPRESS HYPO / HYPER THERM
BURNS
INTER-RELATIONSHIP - RESP, HR, COLOUR
AT BIRTH - SOME -CYANOSIS
60 90 SEC - PINK / ACROCYANOSIS
RARELY - RESP REGULAR FREE
HR 100 MT FLOW
CENTRAL CYANO OXYGEN
INITIAL - HIGH CONCN O2 (80%)
- GRADUAL WEANING TILL
PINK AT ROOM AIR
FREE FLOW OXYGEN
OXYGEN HEATED, HUMIDIFIED
5L / mt
NEARER TO NOSE
1/2 INCH-80% 1 INCH-60%
2INCH-40%
EVALUATION
NO BREATHING/GASP AFTER 2 TACTILES
STIMLNS
CHECK:
RESP EFFORT
HR
COLOUR

BREATHING (N)
HR > 100 / mt SUPPORTIVE CARE
PINK COLOUR
IF NOT - PROTOCOL
PROTOCOL
GASP / NO BREATHING & HR < 100
CHECK HR FOR 6 SEC X 10
CHEST COMPRESSION &
BMV 30 SEC (100%)
HR 60 - 100 APNOEA
BAG & MASK WITH OXYGEN
HR < 60 APNOEA
30 SEC
(N) BREATHING HR
100 & PINK
BMV 30 SEC
FREE FLOW
OXYGEN
HR < 60
HR 100 &
PINK
PINK AT
ROOM AIR
DRUGS & INTUB
OROGASTRIC TUBE FOR BMV > 2 Mts
BAG & MASK VENTILATION
BAG
VALVE ASSEMBLY
SELF INFLATING / AMBU BAG

AIR INLET
OXYGEN INLET
VALVE ASSEMBLY
PATIENT OUTLET
FACE MASK
CUSHIONED RIM
0, 1, 2 SIZES
ROUND / CONICAL
CHECK EQUIPMENT
-BAG BLOCK OUTLET & SQUEEZE
--PR RELEASE VALVE HEAR AIR
RELEASE

CLEAN 2% GLUTARALDEHYDE 20-40
--WASH WITH DISTD WATER
PROCEDURE B M V

POSITION
TEST MOUTH SEAL 2 -3 SQ. CHEST RISE
INITIAL HIGHER PR 30 -40 CM H20
40 PER MT ( 30 60)

CHEST COMPRESSION 90 / mt
(ONE SQ. AFTER 3 COMPRESSIONS)
AFTER 30 SEC, EVALUATE HR, BR, COLOUR

CONTRA
DIA HERNA
M S A F WITH RESP DEPRESSION (INTRA
PARTUM SUCTIONING PRIOR TO BMV)
CHEST COMPRESSION
RHYTHMIC COMPRESSION OF
STERNUM THAT:
COMPRESS HEART AGAINST SPINE
INCREASE INTRATHORACIC PR
CIRCULATE BLOOD TO VITAL
ORGANS
HEART FILLED WHEN PR RELEASED

METHOD
Two thumbs
encircling hands
Two finger
technique of chest
compression In
the two fingers
technique the
index and the
third finger of the
hand is used
LOCATION & DEPTH
RATE OF COMPRESSION
COMPRESSION / RELEASE ACTION 90 / Mt
VENTLN 30 / mt RATIO 3 : 1
HALF SECOND FOR EACH EVENT
IN 2 SECONDS 3 COMPR & 1 SQ
IN 60 SECONDS 90 COMPR & 30 SQ
EVALUATE AFTER 30 SEC
HR 6 SEC X 10
-CAROTID, BRACHIAL, FEMORALS FELT
PRECAUTIONS:
DO NOT REMOVE FINGER / THUMB IN BETWEEN
FEEL THE PULSES FOR EFFECTIVENESS
DO NOT SQUEEZE CHEST