NEONATAL RESUSCITATION

1. NEONATAL RESUSCITATION

2. WELCOME NEONATAL PROCEDURES PRESENTED BY MRS.BENAZEERA ASSISTANTPROFESSOR DEPT.OF YENEPOYA NURSING COLEGE

3. LEARNING OBJECTIVES • Recall the purpose of Neonatal resuscitation • Identify the indication of Neonatal resuscitation • List down the article needed for Neonatal resuscitation. • Explain the techniques of Neonatal Resuscitation procedure

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

5. INDICATIONS • ANTEPARTUM FACTORS • INTRAPARTUM FACTORS

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

7. Articles • Suctioning Articles: • Bulb syringe, • suction catheter No 6,8,10 • mechanical suction

8. Articles 2.Bag and mask articles • Infant resuscitation bag with pressure release valve with reservoir. • Oxygen face mask newborn size • oxygen with flow meter and tubing

9. Articles 3.Intubation articles • Laryngoscope with straight blades • Extra bulb and batteries for scope, • Endotracheal tube size-2.3,3.0 and 4.0mm]

10. Articles 4.Medication • Epinephrine 1:10.000 ampoules. • Normal saline • Ringer’s Lactate • Sodium bicarbonate 4.2./ • Dextrose 10./.concentration 250ml ,sterile water 30ml.

11. Articles 5.Miscellaneous: • Radiant warmer • Stethoscope • Adhesive tape • Bandage • Scissors • Syringe 1ml,5ml and 20ml sizes • Needles No:21,22 and 26 G • Umbilical cord clamp • Gloves • warm dry towel

12. TECHNIQUES OF RESUSCITATION

13. 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?

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

15. NO INITIAL STEPS OF RESUSCITATION

16. 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

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

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

19. 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

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

21. ADMINISTRATION OF OXYGEN • ADMINISTER HIGH CONCENTRATION OF OXYGEN • REGULATE FLOW AT 6L/MIN • USE MASK

22. 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

23. 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

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

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

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

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

28. SITE • LOWER ONE THIRD OF STERNUM RATE • 3 CHEST COMPRESSIONS AND 1 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

29. THUMB TECHNIQUE METHODS TWO FINGER

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

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

33. 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

34. https://www.youtube.com/watch?v=euzRICXcfgk

36. Radiant warmer

37. Learning objectives • Define radiant warmer • Explain the purpose of radiant warmer • List down the parts of Radiant warmer • Discuss the care of neonate in radiant warmer

38. Definition The radiant warmer is a electronically based device which is used to maintain the body Temperature.

39. Purposes • To maintain the body temperature just after the birth • To observe the child under the proper light source • To suction or resuscitation the baby in case of any obstruction or cyanotic episode. • To introduce the medication for long duration e.g.: IV administration

47. Care of the child in Radiant warmer • Check the physician order and instruction • Keep the warmer on before placing the baby and set the temperature as prescribed • Place the sheet over the mattress and tuck it properly 4. Raise the side rails properly 5.Place the baby carefully on the mattress 6. Do the observation of baby under the observation light

48. 7. Provide the feed to the baby intermittently to prevent the dehydration 8.Do not touch the child without hand washing. 9.Maintain hygiene of the child 10. Attend the alarming sign when in on conditions.

49. Care of child withincubator

50. Introduction • Incubator is an apparatus for maintaining an infant, especially a premature infant, in an environment ofcontrolled temperature, humidity, and oxygen concentration. • Incubators have simple alarm systemto alert the clinical staffs if there is any danger of overheating of the device.