NEWBORN RESUSCITATION

3. NEWBORN RESUSCITATION Belen Amparo E. Velasco, M.D.

4. ASSESS AND SUPPORT • TEMPERATURE (warm and dry) • ABC’s • AIRWAY (position and suction) • BREATHING (stimulate to cry) • CIRCULATION (heart rate and • color

5. INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

6. PREPARATION • ADVANCED PREPARATION • IMMEDIATE PREPARATION

7. ADVANCED PREPARATION • OBSTETRICAL TRAY • NB RESUSCITATION TRAY • RADIANT WARMER/DROPLIGHT

8. NB RESUSCITATION EQUIPMENT • Bulb syringe • Endotracheal tube (2.5, 3.0, 3.5) and stylets • Face masks and ambubag • Feeding tubes • Gowns, gloves, goggles • Heat source • Laryngoscope handles and blades • Meconium aspirator • Medications and fluids • Sterile UC set • Suction with manometer/catheters • Syringes (1, 3, 10 and 20 ml) • Warmed blankets

9. IMMEDIATE PREPARATION • BASED ON RESUSCITATION • -ORIENTED HISTORY • VERIFICATION OF AIRWAY • PATENCY AND PLACEMENT • OF VASCULAR CATHETERS

10. RESUSCITATION-ORIENTED HISTORY • MECONIUM STAINING • PREMATURITY • TWIN PREGNANCY • NARCOTICS ADMINISTRATION • TO MOTHER

11. FACTORS ASSOCIATED WITH INCREASED RISK FOR NEONATAL DEPRESSION • ANTEPARTUM MATERNAL FACTORS • INTRAPARTUM MATERNAL OR • FETAL FACTORS

12. ANTEPARTUM MATERNAL FACTORS • Maternal age > 35 or < 18 • Chronic and pregnancy-induced HPN • Diabetes • Hemorrhage • Drug therapy (Mg, lithium, adrenergic-blockers • Substance abuse • Previous abortion • No prenatal care • Anemia or isoimmunization

13. ANTEPARTUM MATERNAL FACTORS • Maternal illness (CV, thyroid, • neurologic) • Multifetal gestation • Small fetus for maternal dates • Post-term fetus • Preterm labor or PROM • Immature pulmonary studies • Oligohydramnios • Diminished fetal activity • Fetal malformation by UTZ

14. INTRAPARTUM MATERNAL OR FETAL FACTORS • Breech or other abnormal presentation • Infection • Prolonged labor • Prolonged rupture of membranes • Prolapsed cord • Maternal sedation • Operative delivery • Meconium-stained AF • Indices of fetal distress

15. UNIVERSAL PRECAUTIONS • GLOVES AND OTHER APPROPRIATE • PROTECTIVE BARRIERS (gowns and • goggles) • SUCTION EQUIPMENT SHOULD • ALWAYS BE AVAILABLE

16. INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

17. INITIAL STEPS OF RESUSCITATION (20 seconds) • PREVENTION OF HEAT LOSS • PROPER POSITIONING • SUCTIONING • TACTILE STIMULATION

18. TEMPERATURE REGULATION • HEAT LOSS MAY BE PREVENTED BY • REMOVING WET LINENS • DRYING THE BABY • PLACING INFANT UNDER • PREHEATED LAMP/RADIANT • WARMER

19. TEMPERATURE REGULATION • ALTERNATIVE METHODS OF WARMING: • WARM BLANKETS/TOWELS • WARM MATTRESSES

20. AIRWAY POSITIONING • PLACEMENT ON BACK OR SIDE WITH • NECK IN NEUTRAL POSITION • SHOULDER ROLL (3/4 OR 1 inch) to • EXTEND NECK SLIGHLY

21. AIRWAY SUCTIONING • IF MECONIUM-STAINED, TRACHEAL • SUCTIONING • BULB SYRINGE SHOULD BE ADEQUATE • IF NOT MECONIUM-STAINED, • SUCTION MOUTH FIRST THEN • NOSTRILS

22. AIRWAY SUCTIONING • MAY USE MECHANICAL SUCTION • WITH 8F OR 10F SUCTION • CATHETERS AT NEGATIVE • PRESSURE NOT TO EXCEED • -100mmHg FOR NO LONGER • THAN 3 to 5 seconds PER • ATTEMPT

23. TACTILE STIMULATION • SLAPPING OR FLICKING THE SOLES • GENTLE RUBBING OF THE BACK

24. ASSESSMENT • RESPIRATORY EFFORT • HEART RATE • COLOR

25. INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

26. OXYGEN • 100% OXYGEN SHOULD BE USED • PREFERABLY WARMED AND • HUMIDIFIED • FREE-FLOW O2 BY O2 HOOD • OR BY FACE MASK ATTACHED TO • AMBUBAG OR SIMPLE MASK • HELD TO FACE WITH 5L/min O2 • FLOW

27. INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

28. POSITIVE-PRESSURE VENTILATION • INDICATIONS • APNEA OR GASPING RESPIRATION • HEART RATE LESS THAN 100 bpm • PERSISTENT CENTRAL • CYANOSIS 100% OXYGEN

29. POSITIVE-PRESSURE VENTILATION • USUALLY PROVIDED WITH BAG • AND MASK • VENTILATORY RATE of 40-60/min

30. INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

31. CHEST COMPRESSION INDICATIONS Persistent bradycardia (60-80/min not increasing) despite 30 seconds of positive pressure ventilation

32. CHEST COMPRESSION • CHEST COMPRESSION AT A RATIO with BAGGING OF 1:3 (Total of 120 events) • TWO METHODS: • Thumb method • Two-finger method

33. INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

34. MEDICATIONS EPINEPHRINE INDICATIONS Heart rate of zero Persistent bradycardia (<60/min) despite 30 seconds of positive pressure ventilation and 30 seconds of chest compression

35. MEDICATIONS VOLUME EXPANDERS INDICATIONS Acute blood loss Non-improvement despite adequate resuscitation

36. MEDICATIONS SODIUM BICARBONATE INDICATIONS Documented metabolic acidosis Cardiac arrest

37. MEDICATIONS NALOXONE INDICATIONS Respiratory depression with maternal history of narcotic intake within four hours from the time of delivery