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REFERENCES:
ILCOR Guidelines 2005
WHO Regional Credentialing Program
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
Antepartum Risks
Maternal diabetes
Chronic maternal illness
Cardiovascular
Thyroid
Neurological
Pulmonary
renal
Pre eclampsia
Maternal infection
Polyhydramnios
Oligohydramnios
Premature rupture of
membranes
IUGR/preterm
Fetal malformation
Maternal substance abuse
No antenatal care
Post term gestation
Multiple gestation
Anaemia
Age <16 or > 35
Intrapartum Risks
Emergency CS
Instrumental delivery
Abnormal position
Premature labour
Precipitous labour
Chorioamnionitis
Prolonged rupture of
membranes
Prolonged labour > 24 hrs
Prolonged 2nd stage of
labour
Fetal bradycardia
Non-reassuring fetal heart
rate pattern
General anaesthesia
Narcotics administered
within 4 hours of delivery
Meconium stained liquor
Prolapsed cord
Abruptio placentae
Placenta previa
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
Endotracheal tubes
Laryngoscope
Stethoscope
Tone
Colour
Respiratory effort
Positioning
Supine or lateral
Head in neutral or slightly extended position
Circulation
Assessment of heart rate and response
to previous measures
Umbilical
arteries
Apex
beat
Auscultation
Pacific EmOC Progr
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
Adrenaline
HR < 60 bpm after 30 seconds of
adequate ventilation and chest
compressions
0.1 - 0.3 mL kg of 1:10,000
Give via ETT, UVC, IV
Repeat dose if no response after 60
seconds
Pacific EmOC Progr
Volume expanders
Not given routinely
Useful in hypovolemia
Normal saline
10mL/kg over 5-10 mins
UVC, IV
If haemorrhagic shock is suspected give whole
blood or packed red cells
Pacific EmOC Progr
Naloxone
Narcotic antagonist
Inadequate spontaneous respiratory effort
Mothers who received narcotics within 4
hrs of delivery
0.1mg/kg of a 0.4 mg/mL solution
ETT, IV, UVC, IM, SC
Monitor babys respirations for further
respiratory depression
Pacific EmOC Progr
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