NEONATAL RESUSCITATION

					1
NEONATAL RESUSCITATION
 Dramatic change from placental gas exchange
 Spontaneous breathing of air
 Physiological changes within 1st minute to hours
 Epidemiology:-
      5%-10% some degree of active
 resuscitation at birth
  1%-10% hospital births need assisted
 ventilation

                                                     2
   EQUIPMENT NEEDED:-
 Suction Equipment                Medications
Me conium aspirator               Epinephrine
Mechanical suction                Naloxone
Suction catheters 10F/12F         Sodium bicarbonate
Feeding tube 6F & 20ml syringe    Sterile water
 Bag & mask equipment             Miscellaneous
Neonatal resuscitation bags       Watch with seconds hand
Face masks,                       Linen with shoulder roll
Oxygen with flow meter & tubing   Radiant wormer
 Intubation equipment            Stethoscope
Laryngoscope                      Adhesive tapes
ET tubes                          Syringes
Stylet                            Gauze
scissors                          Umbilical catheter
                                  Gloves




                                                             3
NEONATAL RESUSCITATION
 4 categories

Basic steps-Rapid assessment
          -Initial steps to stabilize
Ventilation-Bag mask/Bag tube
Chest compression
Medication /Fluids

                                        4
Basic steps:
Determination of need of resuscitation
 Me conium in the amniotic fluid or on the skin
 Cry or respiration
 Muscle tone
 Skin color
 Term or pre term
      should evaluate rapidly.




                                                   5
IF NO ABNOMILITY:
 Warmth
 Clear the airway
 Drying




                     6
IF ABNOMALITY DETECTED:
Further assessment
 Respiration-Grasping/Apnea
 HR<100
 Color- central cyanosis
      -pallor




                               7
     Basic steps to follow

1. Warmth
2. Clearing the air way
3. Positioning
4. Suctioning –if
   assisted delivery




                             8
Basic steps to follow:
1.   Clearing the airway of me conium
2.   Tactile stimulation
3.   Oxygen administration 100% 5L per mini




                                              9
ventilation
 If persistent cyanosis
  despite 100% oxygen
HR<100
Grasping (apnea)
 PPV indicated
40-60 breaths per min
 If not improved-HR<60
Continue assisted ventilation
Begin chest compression
ET intubations




                                10
CHEST COMPRETION
 On lower 3rd of the sternum
 Two thumbs on the sternum
    adjacent to each other
   Other fingers encircling the
    chest and support the back
   Compress to approximately 1/3
    to 1/2of AP diameter
   3:1 ratio of compression to
    ventilation
   90 completion & 30 breaths per
    min.
   Continue HR>60 bpm.



                                     11
MEDICATION.
 Epinephrine
Increase contractility
Stimulate spontaneous contraction
Increase HR
Intravenous or ET doses-0.1-0.3 ml/kg of 1:10 000
Repeat every 3-5 min.




                                                    12
MEDICATIONS
 Volume expanders:
Isotonic saline.
Hartman's solution
Intravenously
10ml/kg-slow infusion 5-10min




                                13
MEDICATIONS:
 Naloxone:
narcotic antagonists
Within 4hrs time
To umbilical vein




                       14
DISCONTINUATION:
 No spontaneous circulation in-15min
 After 10min its unlikely




                                        15
ETHICS:
 Noninitiation or discontinuation depend on
Gastational age
BW
Known undelying conditions
Lak of response to intervention
Religious background of the country




                                               16
REF:
 http://pediatrics.aappublication.org
 Essential Pediatrics (iv Edition) by O.P.Ghai, Piyush
  Guptha, V.K.Paul
 Advanced Pediatric Life Support CD ROM by Prof.
  David Southall




                                                          17
18