Changes and Canadian RecommendationsChanges and Canadian Recommendationsin a Nutshell in a Nutshell

NRP 2006/2007NRP 2006/2007

National guidelines to neonatal resuscitation National guidelines to neonatal resuscitation across several continents are based on the across several continents are based on the consensus statements of the International consensus statements of the International Liaison Committee on Resuscitation Liaison Committee on Resuscitation (ILCOR).(ILCOR).

Each country is expected to develop Each country is expected to develop guidelines that reflect their own context. guidelines that reflect their own context.

The Canadian The Canadian ExpertExpert Committee Committee

Is resuscitation needed?Is resuscitation needed?and the 4 questions to askand the 4 questions to ask

Routine CareRoutine Care

Colour Pink?

Is gone…why??

Easy On the 0xygenEasy On the 0xygen…Wait 90 sec …Wait 90 sec

PPV in air for the 1PPV in air for the 1stst 90 seconds 90 seconds thenthen administer oxygen if saturations are administer oxygen if saturations are

not coming up / infant remains cyanotic not coming up / infant remains cyanotic and Heart Rate < 100and Heart Rate < 100

Infants born <33 wks: Infants born <33 wks: Do not allow sats to go higher than 95% Do not allow sats to go higher than 95% when supplemental 0when supplemental 022 is being used is being used

Canadian Expert CommitteeCanadian Expert Committee ““Oxygen should be administered to babies who Oxygen should be administered to babies who

remain cyanotic at 90 seconds of age”remain cyanotic at 90 seconds of age”

““Wet-in-bag” ResuscitationWet-in-bag” Resuscitation

Gestational Gestational Age < 28wAge < 28w

CPSCPS Maintenance of DR at 25 to Maintenance of DR at 25 to

2626ooC will diminish heat lossC will diminish heat loss If GA < 28w place him below If GA < 28w place him below

the neck in a polyethylene bagthe neck in a polyethylene bag AllAll babiesbabies (term/preterm) (term/preterm)

under radiant warmer by 10 under radiant warmer by 10 min should have servocontrol min should have servocontrol probe probe

The Apgar ScoreThe Apgar Score

LLaryngeal aryngeal MMask ask AAirwayirway

New NRP Adjuncts to Respiratory Care

CO2 Detector

T-Piece T-Piece ResuscitatorResuscitator

Canadian Guideline: PEEP/CPAPCanadian Guideline: PEEP/CPAP

If ongoing positive pressure ventilation If ongoing positive pressure ventilation is required, PEEP of 3-6 cm of water is required, PEEP of 3-6 cm of water should be used should be used

PEEP may be given with a flow-inflating PEEP may be given with a flow-inflating bag or a T-piece resuscitator bag or a T-piece resuscitator

A self-inflating bag with a PEEP valve is A self-inflating bag with a PEEP valve is also an acceptable alternative also an acceptable alternative

Self-inflating bags cannot provide CPAPSelf-inflating bags cannot provide CPAP

Epinephrine AdministrationEpinephrine Administration

Concentration = 1:10,000

Preferred route is IV but give first dose endotracheally while IV is obtained.

Dose IV = 0.1 ml/kg

Dose Endotracheal = 1.0 ml/kg

Administration Rate = rapidly

AAP Canadian Addendum