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    Neonatal Resuscitation

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    api-3850316
    This document provides guidance on neonatal resuscitation. It emphasizes the importance of provider readiness, training, teamwork, and having properly functioning equipment available. It describes the action/evaluation/decision cycle that should be followed during resuscitation. The document then outlines steps for assessing and stabilizing a neonate, including preventing heat loss, clearing the airway, providing positive pressure ventilation or chest compressions if needed, and considering intubation or medications like epinephrine if the heart rate does not improve with initial steps. Drug dosages are also provided. The document stresses the need to consider causes like inadequate ventilation, shock, or congenital anomalies if an infant does not respond to resuscitation efforts.

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    Neonatal Resuscitation

    Uploaded by

    api-3850316
    768 views29 pages
    This document provides guidance on neonatal resuscitation. It emphasizes the importance of provider readiness, training, teamwork, and having properly functioning equipment available. It describes the action/evaluation/decision cycle that should be followed during resuscitation. The document then outlines steps for assessing and stabilizing a neonate, including preventing heat loss, clearing the airway, providing positive pressure ventilation or chest compressions if needed, and considering intubation or medications like epinephrine if the heart rate does not improve with initial steps. Drug dosages are also provided. The document stresses the need to consider causes like inadequate ventilation, shock, or congenital anomalies if an infant does not respond to resuscitation efforts.

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    This document provides guidance on neonatal resuscitation. It emphasizes the importance of provider readiness, training, teamwork, and having properly functioning equipment available. It describes the action/evaluation/decision cycle that should be followed during resuscitation. The document then outlines steps for assessing and stabilizing a neonate, including preventing heat loss, clearing the airway, providing positive pressure ventilation or chest compressions if needed, and considering intubation or medications like epinephrine if the heart rate does not improve with initial steps. Drug dosages are also provided. The document stresses the need to consider causes like inadequate ventilation, shock, or congenital anomalies if an infant does not respond to resuscitation efforts.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    768 views29 pages

    Neonatal Resuscitation

    Uploaded by

    api-3850316
    This document provides guidance on neonatal resuscitation. It emphasizes the importance of provider readiness, training, teamwork, and having properly functioning equipment available. It describes the action/evaluation/decision cycle that should be followed during resuscitation. The document then outlines steps for assessing and stabilizing a neonate, including preventing heat loss, clearing the airway, providing positive pressure ventilation or chest compressions if needed, and considering intubation or medications like epinephrine if the heart rate does not improve with initial steps. Drug dosages are also provided. The document stresses the need to consider causes like inadequate ventilation, shock, or congenital anomalies if an infant does not respond to resuscitation efforts.

    Copyright:

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    of 29

    NEONATAL

    RESUSCITATION

    PRESENTED BY
    PHATTRAPONG TANSUPOL MD.
    หลักการที่จะทำาให้การช่วยฟืน้ ชีวิตประสบความสำาเร็จ

    1.ความพร้อมของบุคลากร
    2.การฝึกฝน
    3.การทำางานเป็นทีม
    4.ACTION/EVALUATION/DECISION CYCLE
    5.อุปกรณ์ที่เพียงพอ และพร้อมใช้งาน
    ACTION/EVALUATION/DECISION CYCLE

    EVALUATION

    ACTION DECISION
    ASPHYXIA – THE BASIC

    1.Primary Apnea:  When asphyxiated,


    the infant responds with a increased RR. 
    If the episode continues, the infant
    becomes apnic, followed by a drop in HR
    and a slight increase in BP.The infant will
    respond to stimulation and therapy with
    spontaneous respirations.
    2. Secondary apnea: after primary
    apnea,  the infant responds with a period
    a gasping respirations, falling HR, and
    falling BP.The infant takes a last breath
    and then enters the secondary apnea
    period.The infant will not respond to
    stimulation and death will occur unless
    resuscitation begins immediately.
    *  Because after delivery of an infant it is impossible to
    differentiate between primary apnea and secondary
    apnea, assume the infant is in secondary apnea and begin
    resuscitation immediately.
    ASPHYXIA CHANGE
    APGAR SCORE
    Anticipation and Recognition of the
    Neonate in Distress
    1.Antepartum and intrapartum history
    Antepartum Factors Intrapartum
    Abnormal Factors
    Age > 35 years presentation
    Maternal diabetes Operative delivery
    Pregnancy-induced Premature labour
    hypertension Premature rupture of
    Chronic hypertension membranes
    Other maternal illness Precipitous labour
    (e.g. CVS, thyroid, neuro) Prolonged labour
    Previous Rh sensitization Indices of fetal
    Drug therapy distress
    (e.g. magnesium, lithium (FHR abnormalities,
    adrenergic-blockers) biophysical profile)
    1.Antepartum and intrapartum history CONT.

    Antepartum Factors Intrapartum Factors


    Maternal substance
    abuse
    No prenatal care
    Maternal narcotics
    Previous stillbirth (within 4 hrs of delivery)
    Bleeding - 2nd/3rd General anaesthesia
    trimester Meconium-stained fluid
    Hydramnios Prolapsed cord
    Oligohydramnios Placental abruption
    Placenta previa
    Multiple gestation
    Uterine tetany
    Post-term gestation
    Small-for-dates fetus
    Fetal malformations
    Equipment

    Equipment and medications should be checked


    as a daily routine and then prior to
    anticipated need. Used items should be
    replenished as soon as possible after a
    resuscitation.
    The delivery room should be kept relatively
    warm and the radiant heater should be
    preheated when possible. Prewarming of
    towels and blankets can also be helpful in
    preventing excessive heat loss from the
    neonate.
    Equipment

    SUCTION EQUIPMENT
    BULB SYRINGE
    SUCTION CATH NO 5 6 8 10 Fr
    8 Fr FEEDING TUBE 20 ml SYRINGE
    MECONIUM ASPIRATOR
    BAG-MASK EQUIPMENT
    FACE MASK
    ORAL AIRWAY
    OXYGEN
    Equipment CONT.
    INTUBATION EQUIPMENT
    LARYNGOSCOPY-BLADE NO 0-1
    BATTERY FOR LARYNGOSCOPE
    ETT NO 2.5 3.0 3.5 4.0 mm
    STYLET SCISSOR GLOVE
    MISCELLANEOUS
    RADIANT WARMER-STETHOSCOPE-TAPE-
    SYRINGE-NEEDLE-ALCOHOL-UMBILICAL CATH
    Initial Steps for Neonatal
    Resuscitation in Delivery Room
    ANTICIPATION
    ASSESSMENT OF ACTION
    1.PREVENT HEAT LOSS
    Place the infant under an overhead
    radiant heater to minimize radiant and
    convective heat loss.
    Dry the body and head to remove
    amniotic fluid and prevent evaporative
    heat loss. This will also provide gentle
    stimulation to initiate or help maintain
    breathing.
    Initial Steps for Neonatal
    Resuscitation in Delivery Room CONT.

    2.ABCDE STEP
    A-AIRWAY
    POSITION
    CLEAR AIRWAY-SUCTION MOUTH
    THEN NOSE
    Initial Steps for Neonatal
    Resuscitation in Delivery Room CONT.

    B-BREATHING ADEQUACY
    1.TACTILE STIMULATION
    slapping or flicking the soles of
    the feet
    rubbing the back gently
    Do not waste time continuing tactile stimulation
    if there is no response after 10 - 15 seconds.
    2.FREE FLOW OXYGEN
    3.PPV
    Initial Steps for Neonatal
    Resuscitation in Delivery Room CONT.

    C-CARDIOVASCULAR
    RESUSCITATION
    D-DRUG
    -DIAGNOSIS
    E-ENVIRONMENT
    -EXTENDED CARE
    Resuscitation in the delivery room
    PPV
    1.INDICATION FOR PPV
    APNEA OR GASPING
    HR < 100 bpm
    CENTRAL CYANOSIS
    2.BAG-Self inflating vs. flow dependent bag
    3. Rate 40-60 bpm
    4. Pressure used =
    a.  Initial breath after delivery = 30-40 cm
    H2O
          b.  Normal delivery = 15-20 cm H2O
           c.  Diseased Lungs =20-40 cm H2O
    PPV CONT.
    5. Technique/Trouble shooting problems
    of Bag mask ventilation
    a. Check for a good seal
        b. Check for a patent airway
         c. Are you using enough pressure ?
    6.Checking for chest movement
    check mask position
    head position-hyperflexion or
    hyperextention
    secretion obstruction
    slighly open infant mount
    checking for pressure
    Chest compression
    1. Indications: 
    If after 15-30 seconds of positive pressure
    ventilation with 100% FIO2 the heart rate is
    a. below 60 bpm
    b.between 60-80 bpm and not increasing
    2. Technique:
    a. 1 fingers breadth below nipple line, using
    2 fingers
           b. 1/2 to 3/4 compression depth
           c. accompanied by ventilations, ratio is 3:1
    METHOD
    ENDOTRACHEAL TUBE INTUBATION

    1.Indications for intubation:


    a.  Prolonged bag and mask ventilation
          b.  Bag and mask is ineffective
          c. Tracheal suctioning
    2.Tube size
    Tube size Weight Gestational Age
    (ID mm) (gm) (weeks)
    2.5 <1000 <28
    3.0 1000-2000 28-34
    3.5 2000-3000 34-38
    3.5-4.0 >3000 >38
    ดูว่าท่อหลอดลมอยู่ในตำาแหน่งท่ีเหมาะสมโดย

    1.ฟั งปอดได้ยินเสียงเท่ากัน 2 ข้าง


    2.ฟั งท่ก
    ี ระเพาะอาหารไม่ได้ยินเสียงลม
    3.ทรวงอกเคล่ อ ื นไหวเท่ากัน 2 ข้าง
    MEDITATION

    1.Indication
    HR < 80 bpm despite 100% O2 and
    chest compression 30 sec
    No heart rate
    Drug
    -adrenaline
    -volume expander
    -NaHCO3

    -Dopamine

    -Naloxone
    hydrochloride
    Drug dosage
    Drug Preparation Dosage Rate/Precautions

    Epinephrine 1 ml 0.01-0.03 Give rapidly IV or ET


    1:10,000 mg/kg Repeat q 3-5 min
    0.1-0.3 ml/kg (ET: dilute to 1-2 ml with
    NS)
    Volume Expanders 40 ml 10 ml/kg Give IV over 5-10 min
    -NS or RL
    -5% Albumin
    -O-neg Blood

    Naloxone 0.1mg/kg Give rapidly


    0.4 mg/ml 1 ml 0.25ml/kg IV or ET preferred
    1.0 mg/ml 1 ml 0.1 ml/kg
    Drug dosage cont.
    Reserved for prolonged
    resuscitations only

    Sodium Bicarbonate 20 ml 2 mEq/kg Give slowly, over at least


    (0.5 mEq/ml = 4.2% soln) 10 mlx2 (4ml/kg) 2 min, IV ONLY, Infant
    must be ventilated

    Dopamine 100 ml Continuous infusion by


    (6 x weight in kg = mg of pump
    dopamine diluted to 100 ml)
    ทารกที่ไม่ตอบสนองควรคิดถึง
    1.inadequate ventilation: missplaced
    ETT,inadequate pressure,air leak
    syndrome
    2.Shoke: asphyxia,hypovolumic,septic
    3.Congenital anomalies: pulmonary
    hypoplasia,severe cardiac disease
    THE END

    Thank you

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