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Neonatal Resuscitation Power Point

This document provides guidance on neonatal resuscitation. It outlines the core knowledge and skills needed which include establishing an airway, providing ventilation and oxygenation, and ensuring adequate cardiac output. The phases of resuscitation and key steps in each phase are described, including preparation, resuscitation, and post-resuscitation care. Key equipment, medications, and techniques for ventilation, chest compressions and intubation are reviewed. Risk factors for needing resuscitation both during pregnancy and delivery are also summarized.

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1K views29 pages

Neonatal Resuscitation Power Point

This document provides guidance on neonatal resuscitation. It outlines the core knowledge and skills needed which include establishing an airway, providing ventilation and oxygenation, and ensuring adequate cardiac output. The phases of resuscitation and key steps in each phase are described, including preparation, resuscitation, and post-resuscitation care. Key equipment, medications, and techniques for ventilation, chest compressions and intubation are reviewed. Risk factors for needing resuscitation both during pregnancy and delivery are also summarized.

Uploaded by

sameerarsw
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Neonatal Resuscitation

Sudeep Kukreja, M.D.


Associate Director, NICU
Children’s Hospital of Orange County
Orange, CA 92868
1
Core Knowledge and Skills

• Airwyays- Establish Clear Airway


• Breathing- Ventilation & Oxygenation
• Circulation- Adequate Cardiac Output
• Reduce Heat Loss

2
Phases of Resuscitation

• Preperation
• Resuscitation
• Postresuscitaion

3
Preparation

• Advance
• Immediate

4
Neutral Thermal Environmental

• Overhead Warmer
• Heat Lamps
• Incubator
• Warm Towels & Blankets
• Warm Water Filled Gloves

5
Resuscitation Equipment

• Organized
• Readily Accessible
• Easy to Assemble

6
Universal Precautions

• Gloves
• Goggles
• Gown

7
Neonatal Drug Preparations

• Precalculated Drugs
• Sodium Bicarbonate 0.5 mEq/L
• Epinephrine 1:10000
• Broselow Tape

8
Resuscitation Assignments

• Team Leader- Airway


• Second Rescuer-
• Pulse Check
• Chest Compression
• Third Rescuer-
• Medications
• Equipment

9
Antepartum Risk Factors

• Maternal Age >35 Yrs. Or <16 Yrs.


• Maternal Diabetes
• Maternal Hemorrhage
• Drug Therapy
• Substance Abuse
• Previous NN Death
• Lack of Prenatal Care
• Maternal Hypertension 10
Antepartum Risk Factors

• Anemia or Isoimmunization
• Maternal Illness
• Multiple Fetuses
• SGA
• Preterm/Postterm Fetus
• Premature ROM

11
Intrapartum Risk Factors

• Abnormal Presentation
• Infection
• Prolonged Labor
• Prolonged ROM
• Prolapsed Cord
• Maternal Sedation
• Meconium Stained Amniotic Fluid
12
Intrapartum Risk Factors

• Abnormal Fetal Heart Rate


• Foul Smelling Amniotic Fluid
• Precipitous Delivery
• Profuse Bleeding

13
Resuscitation-Oriented History

• Multiple Pregnancy
• Meconium Stained Amniotic Fluid
• Prematurity
• Narcotics Use in Previous 4 Hours

14
Resuscitation Priorities

Drying,Warming, Positioning,
Suctioning, Stimulation
BVM Vent
Oxygen
Chest
Compressions
Intubation
Medica
tions
15
Resuscitation Priorities

• Oxygen
• Indications: Dusky, Poor Tone, Breathing Spont.
• Route
• Blow By or Mask if Breathing Spontaneously

16
Bag-Valve-Mask Ventilation

Indications:
• Apnea or Gasping Respiration
• Heart Rate <100 bpm
• Persistent Cyanosis Despite O2 Therapy

17
Bag-Valve-Mask Ventilation
Technique

• Neutral Position of Head


• Tight Mask Seal
• Avoid Pressure on Trachea

18
Ventilation of the Newborn

Assisted rate= 40 to 60 bpm


Signs of Adequate Ventilation:
• Bilateral Chest Expansion
• Bilateral Breath Sounds
• Adequate Heart Rate & Color

19
Indications for Intubation

• BVM Ventilation Not Effective


• Thick Meconium
• Prolonged Postive Press. Vent.

20
Chest Compression

Indications:
Despite Adequate Stimulation & Effective
Ventilation With 100% O2
• Heart Rate <60 bpm
OR
• Heart Rate 60 to 80 but not Increasing

21
Chest Compressions

• Rate: 90 per minute, Interposed by Vent.


• Compression - Ventilation Ratio: 3:1
• Stop Compressions When HR >80 bpm

22
Chest Compressions

Methods:
• Two Finger Chest Compressions
– Two Fingers are Placed Just Below the Nipple
Line
• Hands-Around-the-Chest Compressions
– Two Hands Encircling the Chest
– Two Thumbs at the Nipple Line

23
Medications

Epinephrine:
• Indications: HR <80 bpm Despite IPPV &
Chest Compressions
• Dose: 0.01 to .03 mg/kg IV, ET, IO (0.1 to
0.3 mL/kg of 1:10000
• If no Response to ET , may Increase ET
Dose to 0.1 mg/kg of 1:1000

24
Mesications

Naloxone:
• Indications:
• Respiratory Depression
• Narcotic Administration Within 4 Hours of Delivery
• Dose: 0.1mg/kg IV, ET, IO, SQ
• Caution: May Cause Acute Withdrawal
Symptoms in Infants of Chronically
Addicted Mothers
25
Common Post-Resuscitation
Airway Complications

• Displaced ET Tube
• Obstructed ET Tube
• Pneumothorax
• Equipment Failure
– Inadequate Ventilatory Support
– Gastric Distension

26
Post-Resuscitation Evaluation &
Care

• Temperature Regulation
• Acid-Base Status
• Blood Glucose
• Laboratory Studies
• Chest X-Ray

27
Neonatal Resuscitation

• Time is Life
• Speed is Essential

28
Thank You !

29

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