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NEONATAL RESUSCITATION

NEONATAL RESUSCITATION. PURPOSES. TO INITIATE RESPIRATION IN A NEWBORN WHO IS ASPHYXIATED OR SPONTANEOUS BREATHING HAS NOT INITIATED. INDICATIONS. ANTEPARTUM FACTORS INTRAPARTUM FACTORS. PREPARATION FOR RESUSCITATION. TWO TRAINED PERSONNEL NEEDED

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NEONATAL RESUSCITATION

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  1. NEONATAL RESUSCITATION

  2. PURPOSES • TO INITIATE RESPIRATION IN A NEWBORN WHO IS ASPHYXIATED OR SPONTANEOUS BREATHING HAS NOT INITIATED.

  3. INDICATIONS • ANTEPARTUM FACTORS • INTRAPARTUM FACTORS

  4. PREPARATION FOR RESUSCITATION • TWO TRAINED PERSONNEL NEEDED • KEEP READY RESUSCITATION EQUIPMENTS

  5. TECHNIQUES OF RESUSCITATION

  6. SIGNS TO EVALUATE • PERFORMED WITHIN FEW SECONDS • FIVE QUESTIONS TO BE ANSWERED • Is the amniotic fluid clear of meconium? • Is the newborn breathing or crying? • Is there good muscle tone? • Is the colour pink? • Was the newborn born at term?

  7. YES ROUTINE CARE • PLACING NEWBORN ON MOTHERS ABDOMEN • DRYING AND COVERING • WIPING NEWBORN MOUTH AND NOSE USING CLEAN CLOTH

  8. NO INITIAL STEPS OF RESUSCITATION

  9. PROVISION OF WARMTH • PREHEAT THE RADIANT WARMER • RECEIVE NEWBORN IN A DRY AND WARM LINEN • PLACE BABY UNDER WARM SOURCE • DRY BODY • WRAP IN ANOTHER SHEET

  10. POSITIONING • EXTEND THE HEAD BY PLACING ROLLED TOWEL UNDER SHOULDER

  11. CLEARING AIRWAY • If no meconium - suction secretions from mouth and nose - mouth first then nose

  12. If meconium present - suction before delivery of shoulders -continue initial steps of resuscitation If newborn is depressed -suction under supervision of laryngoscope -Intubate trachea and suction

  13. TACTILE STIMULATION • SLAPPING /FLICKING THE SOLE OF THE FEET • GENTLY RUBBING THE BACK • IF NO RESPONSE START BAG AND MASK

  14. ADMINISTRATION OF OXYGEN • ADMINISTER HIGH CONCENTRATION OF OXYGEN • REGULATE FLOW AT 6L/MIN • USE MASK/TUBE ½ INCH AWAY FROM NEWBORN FACE

  15. CHECK HR, RESPIRATION,COLOUR • Spontaneous breathing with HR >100/min Continue administration of oxygen • If apnea/ gasping/cyanosis after 30 sec Assisted ventilation by bag and mask

  16. POSITIVE PRESSURE VENTILLATION • Cover the mouth, nose and tip of chin • Administer at a rate of 40-60 /minute • Hold mask using left hand and compress bag using finger tip

  17. If no improvement in color, heart rate or breathing • Check for air leakage • Blocked airway • Inadequate pressure

  18. Reapply mask • Reposition head • Check for secretions • Ventilate with mouth slightly opened • Increase pressure of ventilation • Recheck the resuscitation bag

  19. Positive pressure ventilation for 30 sec Assess heart rate, color, breathing • HR >100, COLOR IMPROVING • FREE FLOW OF OXYGEN • HR< 60 • CHEST COMPRESSION

  20. CHEST COMPRESSION • Firmly support neonates back • Two trained personnel needed-chest compression and vantilation

  21. SITE • LOWER ONE THIRD OF STERNUM RATE • 3 CHEST COMPRESSIONS AND1 BREATH • COMPRESS CHEST TO A DEPTH OF ONE THIRD OF A.P DIAMETER OF CHEST • EVALUATE AFTER 30 SEC • IF HR <60 CONTINUE CHEST COMPRESSION • IF HR >60 CONTINUE VENTILLATION

  22. METHODS TWO FINGER THUMB TECHNIQUE

  23. ENDOTRACHEAL INTUBATION

  24. INDICATIONS • TO SUCTION TRACHEA • SUSPECTED DIAPHRAMATIC HERNIA • NON RESPONSE TO BAG AND MASK VENTILLATION • PROLONGED POSITIVE PRESSURE VENTILLATION REQUIRED • ADMINISTER EPINEPHRINE

  25. TECHNIQUES • INTRODUCE E T TUBE TO A LEVEL • CONFIRM THE TUBE PLACEMENT • LENGTH OUTSIDE SHOULD BE 4 cm • CONNECT TO BAG AND MASK • ATTEMPTS TO BE LIMITED TO 20 sec

  26. MEDICATIONS • ADRENALINE – STIMULATE HEART • NALOXONE - POOR RESPIRATORY EFFORT NARCOTIC ADMINISTRATION TO MOTHER • VOLUME EXPANDERS- ACUTE BLOOD LOSS

  27. TERMINATION OF RESUSCITATION • IF HR NOT IMPROVED WITH CENTILLATION AND CHEST COMPRESSION AND ADRENALINE • NO HR AND BREATHING AT BIRTH AND NOT INPROVED AFTER 10 min OF RESUSCITATION

  28. Thank you

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