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    Special Considerations: Resuscitation of Premature Babies

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    wahyuwirawan
    This document discusses special considerations for resuscitation of premature babies, including potential complications, post-resuscitation management, and resuscitation outside of the hospital. It provides guidance on ventilation, oxygenation, temperature control, and potential difficulties that may be encountered such as an inability to ventilate or cyanosis despite ventilation. Ethical considerations are discussed around determining goals of care with parents and situations where resuscitation may not be initiated.

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    Special Considerations: Resuscitation of Premature Babies

    Uploaded by

    wahyuwirawan
    745 views30 pages
    This document discusses special considerations for resuscitation of premature babies, including potential complications, post-resuscitation management, and resuscitation outside of the hospital. It provides guidance on ventilation, oxygenation, temperature control, and potential difficulties that may be encountered such as an inability to ventilate or cyanosis despite ventilation. Ethical considerations are discussed around determining goals of care with parents and situations where resuscitation may not be initiated.

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    This document discusses special considerations for resuscitation of premature babies, including potential complications, post-resuscitation management, and resuscitation outside of the hospital. It provides guidance on ventilation, oxygenation, temperature control, and potential difficulties that may be encountered such as an inability to ventilate or cyanosis despite ventilation. Ethical considerations are discussed around determining goals of care with parents and situations where resuscitation may not be initiated.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    745 views30 pages

    Special Considerations: Resuscitation of Premature Babies

    Uploaded by

    wahyuwirawan
    This document discusses special considerations for resuscitation of premature babies, including potential complications, post-resuscitation management, and resuscitation outside of the hospital. It provides guidance on ventilation, oxygenation, temperature control, and potential difficulties that may be encountered such as an inability to ventilate or cyanosis despite ventilation. Ethical considerations are discussed around determining goals of care with parents and situations where resuscitation may not be initiated.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 30

    Special considerations

    Resuscitation of premature babies


    Ethics and Care at End of Life
    Special considerations
     Situations that may complicate
    resuscitation and cause ongoing problem
     Post-resuscitation management
     Resuscitation outside hospital or beyond
    time of birth
    Difficult situations
     Not able to ventilate adequately
     Cyanosis despite adequate ventilation
     Bradycardia despite adequate ventilation
     No spontaneous breathing despite
    adequate ventilation
    Not able to ventilate
     Mechanical blockage of airways
     Meconium or mucus in pharynx or trachea
    Tracheal suction
     Choanal atresia
    Pass small-caliber suction catheter, oral airway
     Pharyngeal malformation (Robin syndrome)
    Prone, nasopharyngeal airway
     Other rare conditions (laryngeal web)
    Emergency tracheostomy
    Not able to ventilate
     Impaired lung functions
     Pneumothorax
    Diminished air entry, transillumination, X-ray, drain
     Congenital pleural effusion
    Hydrops, Drain
     Congenital diaphragmatic hernia
    Intubate, orogastric tube
     Pulmonary hypoplasia
     Extreme prematurity High inflation pressure
     Congenital pneumonia
    Cyanosis/Bradycardia despite
    adequate ventilation

     Cyanotic heart disease


     Congenital heart block

    Ensure adequate ventilation


    No spontaneous breathing despite
    adequate ventilation
     Brain injury (HIE, severe acidosis,
    congenital neuromuscular disorder)
     Sedation due to drugs given to mother
    (narcotic drugs, magnesium sulfate,
    general anesthesia, non-narcotic
    analgesics)
    Naloxone
     Indications
     Continued respiratory depression after PPV
    has restored a normal heart rate and color
    AND
     History of maternal narcotic administration
    within past 4 hours
    Naloxone
     Recommended concentration = 1.0 mg/ml
     Route: IV preferred; IM acceptable but
    delayed onset of action; ET not
    recommended
     Dose: 0.1 mg/kg
     May require repeated administration
    Post-resuscitation care
     Temperature control
     Close monitoring of vital signs
     Laboratory studies
    Post-resuscitation care
     Look for complications
     Pulmonary hypertension
     Pneumonia/other lung complications
     Metabolic acidosis
     Hypotension
     Seizures
     Apnea
     Hypoglycemia
     Feeding problem
    Resuscitation outside hospital or
    beyond time of birth
     Same principles (Restore adequate
    ventilation)
     Alternative heat source (Skin-to-skin contact)
     Clear airway (Bulb syringe, wipe with a cloth)
     Ventilation (Mouth-to-mouth-and-nose)
     Vascular access (Peripheral vein
    cannulation/intraosseus needle)
    Resuscitation and Prematurity
     Thin skin, large surface area and ↓ fat
     Oxygen toxicity
     Weak muscles - difficulty in breathing
     Immature nervous system –less respiratory
    drive
     Immature lung
     Fragile brain capillaries
     Small blood volume
    Additional Resources Needed
     Additional trained personnel
     Additional means of maintaining temperature
     Re closable, food grade polyethylene bag
     Portable warming pad
     Transport incubator

     Additional means to control oxygenation


    (in a hospital in which babies at <32 weeks gestation are born electively)
     Compressed air source
     Oxygen blender
     Pulse oximeter
    Keeping a premature baby warm
     Increase temperature of the delivery room
     Pre-heat the radiant warmer
     Pre- warmed transport incubator
    Keeping a premature baby warm
     If baby is born at less
    than 28 weeks
    gestation, consider
    placing him below the
    neck in a re closable
    polyethylene bag
    without first drying the
    skin
     Avoid overheating
    Oxygen in a premature baby
     Connect a blender to compressed oxygen and
    air sources and to PPV device
     Start somewhere between room air and 100%
    oxygen
     Attach a pulse oximeter to baby’s foot or hand
     Heart rate displayed by pulse oximeter should
    agree with heart rate that you palpate or hear
    Oxygen in a premature baby
     Adjust oxygen concentration to achieve an
    oxygen saturation that gradually increases
    to 90%
     Accept 70% to 80% if-heart rate is
    increasing and oxygen saturation is
    increasing
     If saturation is less than 85% and not
    increasing, increase oxygen concentration
     Decrease oxygen concentration of
    saturation rises above 95%
    Oxygen in a premature baby

    !
    Resuscitation efforts not to be
    delayed while waiting for pulse
    oximeter to display a strong
    signal
    Ventilation in a premature baby
     Consider giving CPAP if the baby Is breathing
    spontaneously and has a heart rate above 100
    bpm but has
     Labored breathing or
     Is cyanotic or
     Has low oxygen saturation

     By using flow-inflating bag or T-piece


    resuscitator
    CPAP
    Ventilation in a premature baby
     Use lowest inflation pressure necessary to
    achieve adequate response
     Initial inflation pressure of 20-25 cm H2O
     May need higher pressure if no
    improvement in heart rate and no chest
    rise
    Ventilation in a premature baby
     Prophylactic surfactant as per your
    practice

    ! Baby should be fully


    resuscitated before surfactant
    is given
    How to decrease chances of brain
    injury in a premature baby?
     Gentle handling
     No head-down position
     Avoid excessive positive pressure or CPAP
     Adjust ventilation and oxygen concentration
    gradually and appropriately (use pulse
    oximeter and blood gas)
     Do not give rapid infusion of fluids
     Avoid infusion of hypertonic solutions
    Post-resuscitation management of
    a premature baby
     Monitor blood sugar
     Monitor for apnea and bradycardia
     Give and adjust ventilation and oxygen
    concentration gradually and appropriately
     Give feeding slowly and cautiously
     Increase suspicion of infection
    Ethics and neonatal resuscitation

     Primary role in determining goals of care


    with parents
     Informed consent based on complete and
    reliable information (may not be available
    before or immediately after delivery)
    Not to initiate resuscitation
     Confirmed gestational age of less than 23
    weeks or birth weight less than 400 gm
     Anencephaly
     Confirmed trisomy 13 or 18
     If parents wish: confirmed gestational age
    of 24-25 weeks

    Based on your survival rates and local policy


    Counseling parents before a high
    risk birth
     Obstetrician and neonatologist perspectives
    may be different
     Short and long term outcome of babies of
    different gestation in your hospital
     Discuss resuscitation and level of care to
    be given to baby
     Documentation
    When to stop resuscitation?
     No heart rate after 10 minutes of complete
    and adequate resuscitation
     No evidence of other causes of
    compromise

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