Neonatal resuscitation

1. Neonatal resuscitation Mr Matthews

2. Apgar Score • The Apgar score is a score describing an infant's condition for each sign at 1 minute and 5 minutes after the birth. • If the score is below 7, it is continued every 5 minutes until normal or 20 minutes of age. • A score of 7–10 is considered normal, while 4–7 might require some resuscitative measures • A baby with Apgar score of 3 and below requires immediate resuscitation.

3. Apgar score

4. WHICH BABIES REQUIRE RESUSCITATION? • Most Newly Born Babies Are Vigorous • Only Approximately 10% Newborns Require Some Assistance • Only 1% Need Major Resuscitative Measures, e.g. Intubation, Chest Compressions, And/Or Medications, To Survive

5. Can you describe an Apgar score in preterm infants? • Is the Apgar score a good indicator of long-term neurological outcome?

6. NEWBORN RESUSCITATION • THE CLINICAL SEQUENCES? • HOW TO BE READY & • CARRY OUT RESUSCITATION?

7. THE WHO Guidelines • ANTICIPATE • Be Prepared For Every Birth By Having Skill To Resuscitate • Review The Risk Factors, If Any, For Perinatal Asphyxia • Clearly Decide On The Responsibilities Of Each Hlth Care Provider During NR • Remember That The Mother Is Also At Risk Of Complications • The Following Questions Should Be Answered After Every Birth: • Is The Amniotic Fluid Clear Of Meconium? • Is The Newborn Baby Breathing Or Crying? • Is There A Good Muscle Tone? • Is The Color Pink? • Is The Newborn Baby Born At Term? • If The Answer = No To Any Of These, Then Consider Resuscitation Immediately

8. PREPARATION FOR RESUSCITATION: PERSONNEL AND EQUIPMENT • FACTS • Every Delivery To Be Attended By At Least 1 Person Whose Only Responsibility Is The Baby & Who Is Capable Of Initiating Resuscitation • Either That Person Or Someone Else Who Is Immediately Available Should Have Skills Required To Perform A Complete Resuscitation • When Resuscitation Is Anticipated, Additional Personnel Should Be Present In The DR Before The Delivery Occurs • Prepare Necessary Equipment • Turn On Radiant Warmer • Check Resuscitation Equipment

9. PREPARE FOR BIRTH • 2 Clean Towels For Thermal Protection & OTHERS • Small Blanket Oral Airway • A Suction Device ( Mucus Extractor) Ambubag • A Radiant Heater (If available) Stethoscope • A Draught-Free Delivery Room > 25oC Endotracheal Tubes • Clean Delivery Kit For Cord Care, Gloves Laryngoscope • Two Infant Masks (Normal) Face Mask • A Clock Oxygen Delivery Unit • An Additional Set Of Equipment In Reserve 50% Dextrose Water • For Multiple Births Normal Saline/Ringers Lactate • Umbilical Catheter

10. RESUSCITATION PROCESS • INITIAL STEP: AIRWAY(Strategy A) A • Airway – Positioned, Free & Cleared As Necessary* • Provide Warmth • Dry & Stimulate The Baby To Breathe • Open Airway By Positioning The Newborn In “Sniffing” • Position: On Back, Slightly Extending Neck. • “Sniffing” Position Aligns Posterior Pharynx, Larynx, & Trachea • Suction Mouth First, Then Nose; “M” Before “N” • B • B C • C *Consider Intubation Of Trachea At This Point (For Depressed Newborn With Meconium-Stained Fluid)

11. THE NEXT STEP:BREATHING (Strategy B) • If Apneic Or HR < 100 bpm: Provide Positive-Pressure Ventilation (PPV) • If Breathing, & HR >100 bpm But Baby Is Cyanotic, Then Offer Supplemental O2 • If Cyanosis Persists, Provide PPV – With 100% O2 Or Room Air If 100% O2N/A

12. NEXT STEP: CIRCULATION/CARDIAC(StrategyC) • If HR<60 bpm Despite Adequate Ventilation For 30 Seconds: • Provide Chest Compressions As You Continue Assisted Ventilation • Then Evaluate Again; If HR Still <60 bpm, Then Start Strategy D

13. HOW PERFORM CHEST COMPRESSIONS & VENTILATIONS? • Thumb Technique: • Place Your Thumbs Side By Side Or, On A small Baby, 1 Over The Other, Just Above Xyphoid. The Other Fingers Provide Support Needed For The Back • You Pressure As To Depress The Sternum To A Depth 1/3 Of The • Ant/Post Diameter Of The Chest, Approximately; Then Release • The Downward Stroke Should Be Somewhat Shorter Than Duration Of • The Release • Your Thumbs Should Remain In Contact With The Chest At All Times • RATE? 90 Compressions + 30 Breaths Per Minute • i.e. Sequence Of: 3 to 1 • ”1 and 2 and 3 and Breath, and 1 and 2 and 3 and Breath …......”

14. NEXT STEP: Drug(s)(Strategy D) • If HR Is <60 bpm Despite Adequate Ventilation & Chest Compressions : • Administer Epinephrine & Continue Assisted Ventilation With Chest • Compressions • Epinephrine Dose: • The Recommended IV Or Endotracheal Dose Is: 0.1 - 0.3 mL/kg , Of 1:10,000 Solution (0.01 to 0.03 mg/kg) Repeated Every 3 To 5 Minutes As Indicated • Higher Doses Associated With Increased Risk Of ICH & Myocardial Damage • No Differing Dose For Premature Newborn Babies

15. VITAL Points In The Neonatal Resuscitation Flow Diagram • The Most Important & Effective Action In NR Is To Ventilate Baby’s Lungs • Effective P-PV In Secondary Apnea Usually Results In Rapid HR Improvement • If HR Does Not Increase, Ventilation Could Be Inadequate And/Or Chest • Compressions & Epinephrine May Be Needed • HR <60 bpm → Additional Steps Needed • HR >60 bpm → Chest Compressions Can Be Stopped • HR >100 bpm & Breathing → P-PV Can Be Stopped • Time Line: If No Improvement After 30 Seconds, Proceed To Next Strategy/Step

16. Potentially Hazardous Forms Of Stimulation • Slapping Back Or Buttocks • Squeezing Rib Cage • Forcing Thighs Onto Abdomen • Dilating Anal Sphincter • Hot Or Cold Compresses Or Baths • Shaking • DRUGS, e.g. Hydrocortisone, NaHCO3 - Especially With Apnea