RESUSITASI NEONATUS

Irma Amalia

Berlaku untuk
Bayi baru lahir: masa transisi
intrauterin dan ekstra uterin
Telah mengalami transisi masa lahir
dan membutuhkan resusitasi pada
minggu pertama kehidupan (initial
hospitalization)

Neonatal Resuscitation Equipment

1.Suction Equipment

2.
3.
4.
5.

Bulb Syringe/mechanical suction and tubing

Suction catheter

Bag and mask equipment

Intubation equipment
Pulse oxymeter
Medications :
Epinephrine 1/10.000
Isotonic crystaloid
Dextrose 40 %
Normal saline
Umbilical Vessel catetherization supplies
5. Tambahan
Gloves, radiant warmer, linens, stethoscope, oropharyngeal
airway

BULB SYRINGE

APGAR Score
Score
Sign

Heart Rate

Absent

< 100/ m

100/ m

Respiratons

Slow, irregular

Good, crying

Muscle tone

Limp

Some flexion

Active motion

Reflex
irritability

No response

Grimace

Cough,
sneeze,cry

Colour

Blue or pale

Pink body, blue

extremitas

Completely
pink

- Assigned at 1 and 5 minute after birth

- If < 7 every 5 minute 20 minute

BAYI BARU LAHIR

Bernafas dan menangis delayed cord
clamping ( sekitar 30 detik) DCC is
associated with less intraventricular
hemorrhage (IVH) of any grade, higher
blood pressure and blood volume, less
need for transfusion after birth, and
less necrotizing enterocolitis.
Tidak bernafas atau tidak menangis
cord clamped resusitasi

SATU SAJA
Langkah awal/
Initial step
stabilisasi HAPE
BEKAS

 Term gestation?
Crying or breathing?
Good muscle tone?
THREE yes, not need resuscitation
keringkan, placed skin-to-skin with the mother,
and covered with dry linen to maintain
temperature Observation of breathing,
activity, and color should be ongoing.
Suction dilakukan hanya jika sekret kental dan/
atau menghalangi jalan nafas

Golde
n
minut
e

RESPIRATIONS:
apnea, gasping,
or labored or
unlabored
breathing
HEART RATE
less than
100/min

POSITIVE PRESSURE VENTILATION

Indication:
1. Apnea or gasping breathing
2. Heart rate < 100 bpm
3. Persistent central cyanosis despite FI O2 100%
Use : 1. Flow inflating bag
2. Self inflating bag
Rate : 40 60 breath per minute satu lepas lepas
Pressure : 30 40 cm H2O and then

Appropriate PPV is followed by :

- Increase of heart rate
- Improved in color
- Spontaneous breathing
The most sensitive indicator of a successful
response to each step is an increase in
heart rate

 Setelah PPV, penilaian ditambah

saturasi oksigen heart rate,
respirations, and oxygen saturation
A pulse oximeter
+ provide a continuous assessment
- Lama: 1-2 mnt

Chest Compressions

Two thumb tech. LEBIH EFEKTIF

Indikasi: HR < 60/min padahal ventilasi sudah adekuat
LOKASI: sepertiga bawah sternum
KEDALAMAN:sepertiga diameter anterior posterior
3:1 = compressions : ventilation 90 compressions and 30
breaths = 120 events per minute to maximize ventilation at an
achievable.
Thus, each event will be allotted approximately a half of a
second, with exhalation occurring during the first compression
after each ventilation.
A 3:1 compression-to-ventilation ratio is used for neonatal
resuscitation where compromise of gas exchange is nearly
always the primary cause of cardiovascular collapse, but
rescuers may consider using higher ratios (eg, 15:2) if the
arrest is believed to be of cardiac origin.

Epinephrine
DOSIS 0.01 to 0.03
mg/kg of 1:10 000
epinephrine INTRAVENA
(Umbilical vein)
ETT 0.05 to 0.1 mg/kg
Repeat every 3 5
minutes

Endotracheal Intubation
Indications :
1. to improve ventilation in bag and mask
ventilation in effective
2. To coordinate ventilation and chest
compression
3. To administration medication such as
epinephrine
4. When prolonged ventilation is needed
5. Administer surfactant
6. When congenital diaphragmatic hernia is
suspected.

Volume Expansion
Volume expansion may be considered when blood loss is
known or suspected (pale skin, poor perfusion, weak
pulse) and the infants heart rate has not responded
adequately to other resuscitative measures.
An isotonic crystalloid solution or blood may be
considered for volume expansion in the delivery room.
The recommended dose is 10 mL/kg, which may need
to be repeated.
When resuscitating premature infants, it is reasonable to
avoid giving volume expanders rapidly, because rapid
infusions of large volumes have been associated with
IVH

Postresuscitation Care
Cegah hipoglikemia
Hipoglikemia brain injury
Cegah Hypothermia

Discontinuing Resuscitative
Efforts
An Apgar score of 0 at 10 minutes is a strong predictor of
mortality and morbidity in late preterm and term infants.
We suggest that, in infants with an Apgar score of 0 after
10 minutes of resuscitation, if the heart rate remains
undetectable, it may be reasonable to stop assisted
ventilation; however, the decision to continue or
discontinue resuscitative efforts must be individualized.
Variables to be considered may include whether the
resuscitation was considered optimal; availability of
advanced neonatal care, such as therapeutic
hypothermia; specific circumstances before delivery (eg,
known timing of the insult); and wishes expressed by the
family

DISCONTINUATION OF RESUCITATION 2010

In a newly born baby with no

detectable
heart
rate,
it
is
appropriate to consider stopping
resuscitation if the heart rate
remains undetectable for 10 minutes
(Class IIb, LOE C.

Referensi
2015 American Heart Association
Guidelines Update for
Cardiopulmonary Resuscitation
and Emergency Cardiovascular
Care. Part 13: Neonatal
Resuscitation
Special ReportNeonatal
Resuscitation:
2010 American Heart Association
Guidelines for Cardiopulmonary