prof. rai muhammad asghar...prof. rai muhammad asghar dean of pediatrics rawalpindi medical...

Prof. Rai Muhammad AsgharDean of Pediatrics

Rawalpindi Medical University

www.drraiasghar.com

Neonatal Resuscitation

Neonatal Resuscitation

• Resuscitation is active intervention to

establish normal cardio respiratory

function

• 5-10% require active intervention

Goal

• To prevent morbidity & mortality associated

with hypoxic ischemic tissue

(brain, heart, kidney) injury

• Anticipate high risk situations

Guideline for neonatal resuscitation

Integrated assessment / response approach for

initial evaluation of an infant

- Color

- General appearance

- Risk factor

Fundamental Principles

- Evaluation of airway

- Establishing effective respiration

- Establishing adequate circulation

Immediate Care

- Place under radiant heater

- Dry

- Position (head down & slightly extended)

- Clear airway

- Gentle tectile stimulation

Assess

- Infant is color

- Heart rate

BIRTH

Term gestation?

Amniotic fluid clear?

Breathing or crying?

Good muscle tone?

Routine care

. Provide warmth

. Clear airway if needed

. Dry

. Assess color

Provide warmth

Position; clear airway*

(as necessary)

Dry, stimulate, reposition

Evaluate respirations

Heart rate, and colorObservational Care

Yes

Approximate

time

Breathing

HR>

& Pnk

30 S

eco

nds

The Fetus and Neonatal Infant

Give supplementary

Oxygen

Provide positive –pressure ventilation

Provide positive pressure ventilation

Administer chest compression

Administer epinephrine and or volume*

Postresuscitation Care

Evaluate respirations

Heart reate, and color

Observational Care

Breathing

HR>

& Pnk

Pink

Apnea or

HR <100

Breathing

HR>100 but

Cyanotic

Persistent

Cyanosis

Effective

Ventilation

HR>100 &

pink

HR<60 HR>60

HR<60

B

C

D

30 S

eco

nds

30 S

eco

nds

BIRTH

Term gestation?

Amniotic fluid clear?

Breathing or crying?

Good muscle tone?

Routine care

. Provide warmth

. Clear airway if needed

. Dry

. Assess color Provide warmth

Position; clear airway*

(as necessary)

Dry, stimulate, reposition

Evaluate respirations

Heart rate, and colorObservational Care

Yes

Approximate

time

Breathing

HR>

& Pink

30 S

eco

nds

The Fetus and Neonatal Infant

Give supplementary

Oxygen

Provide positive –pressure ventilation

Provide positive pressure ventilation

Administer chest compression

Administer epinephrine and or volume*

Breathing

HR>100 but

Cyanotic PinkApnea or

HR <100

Postresuscitation Care

Persistent Cyanosis

Effective

Ventilation

HR>100 & pink

HR<60 HR>60

HR<60

A

B

C

D

30 S

eco

nds

30 S

eco

nds

No

Respiratory Effort

Steps

Follow ABCs

A- Anticepate & establish

B- Initiate Breathing

C- Maintain Circulation

D- Drugs

If no respiration or heart rate below

100/min

- Give positive pressure with face mask

- Ecdotracheal intubation

If heart does not improve then:

- Start chest compression

- Site

Lower third of sternum

3:1

If no improvement

give epinephrine

Poor response to Ventilation

- Loosely fitted mask

- Poor position of ETT

- Intraesophageal intubation

- Airway Obstruction

- Insufficient pressure

- Excess Air in Stomach

Administration of Naloxone Hydrochloride

Ind: - Respiratory depression

- Mother has H/O narcotic

- Drug administration

Dose:- 0.1mg/kg ½, intratracheal

Emergency Volume Expander

- Isotonic crystalloid solution

10-20ml/kg

- O -ve blood

Sodium Bicarbonate

- Indication

- Documented metabolic acidosis

- Prolong resuscitation

- Dose - 2meq/kg ½

Dopamine or Dobutamine

Ind:

- Cardiogenic shock

- Dose 5-20mg/kg/min

Infusion Epirephrine

Ind:

- Unresponsive Cardiac shock

Dose:

- 0.1-1.0mg/kg/min

Primary Apnea

→Asphyxia →Reduce

Heart rate → apnea

Immediate Intervention

- Oxygen inhalation

- Tectile stimulation

Secondary Apnea

- Gasping respiration

- Bradycardia

- Hypotension

- Finally apnea

Immediate Intervention

- Positive pressure ventilation

Equipment Required

- Resuscitation table

- Sterile Linen

- Suction apparatus ( Catheter 5, 6, 8)

- Laryngoscope with straight blade

- Ambo bag with face mask

- Endotracheal tube

- Gloves

Medication

- Epinephrine 1:10,000

- Naloxone hydrochloride

- Volume expander

- Soda bicarbonate

- 10% Dextrose water

- Sterile water

Miscellaneous

- Radiant warmer

- Stethoscope

- Adhesive tape

- Syringes

- Butterfly needle

- Umbilical artery

- Catheterization tray

Indication for Endotracheal tube

Intubation

- Ineffective bag & mask ventilation

- Prolong PPV required

- Suspicion of diaphragmatic hernia

-Preterm infant

-Meconium aspiration

Stop Resuscitation

If no respiratory & cardiac activity after 20

min of resuscitation

Fixed pupil