NEONATAL RESUSCITATION Prof. Pradeep G.C.M Consultant Neonatologist M.S.Ramaiah Medical college Bangalore

Why learn Neonatal Resuscitation? Asphyxia - 19% of neonatal deaths Resuscitation – can improve outcome of  1 million babies 10% babies require resuscitation 1% - extensive resuscitative measures

Myths in neonatal resuscitation

Myth 01 Resuscitation is done by “qualified pediatrician” only

Who should resuscitate? At every delivery there should be at least 1 person whose primary responsibility is the newly born The person must be capable of initiating resuscitation, including administration of positive-pressure ventilation and chest compressions

Myth 02 Resuscitation is a complex process involving chest compressions / Intubation

Myth 03 Only high risk vaginal deliveries /LSCS require person for resuscitation

Risk factors Birth asphyxia can be caused by events that happen in either the antepartum, the intrapartum, or the postpartum periods or combinations of above Birth asphyxia could occur in deliveries without any known risk factors

Myth 04 We cannot resuscitate without oxygen !!

Room air resuscitation In term infants requiring resuscitation room air resuscitation has shown to be as effective and better than 100% oxygen

Myth 05 Chest compressions and adrenaline is important along with ventilation of lung

Neonate’s first breaths

Cardiopulmonary adaptation

In-utero or perinatal compromise

Physiology of resuscitation Ventilation of the lung is the most important step in neonatal resuscitation !!

Neonatal resuscitation

Steps for Successful resuscitation Anticipation Preparation Prompt intervention

Preparation Warm labor room, radiant warmer Sterile gloves Warm linen Check list for equipment Working condition !!!

Check list Suction equipment Suction machine, suction catheters Bag & mask equipment Oxygen source, masks, reservoirs Intubation equipment laryngoscope, ET tube, stylet, tape Medications adrenaline, normal saline, syringes

Overview of NRP 2010

INITIAL ASSESSMENT

INITIAL ASSESSMENT Action in sequence !!!

T - ABC T – temperature A – airway B – breathing C – circulation

Initial Steps Provide warmth Position clear airway Dry, stimulate, reposition

Initial Steps Provide warmth Position clear airway Dry, stimulate, reposition

Warmth “COLD” welcome Amniotic fluid 37 C Labor room - 20-28 C Switch on 10 min before 3 pre-warmed towels No draughts of air

Initial Steps Provide warmth Position clear airway Dry, stimulate, reposition

Position

Correct Position

Position To help maintain correct position, you may place a rolled blanket or towel under the shoulder

Initial Steps Provide warmth Position clear airway Dry, stimulate, reposition

Clear airway

Clear airway

Initial Steps Provide warmth Position clear airway Dry, stimulate, reposition

Dry

Stimulate Drying, suctioning 1-2 times Don’t waste time Don’t slap Don’t shake

After initial steps

VENTILATION

Self Inflating Bag Size of bag – 240 to 750 ml 2. Oxygen inlet 7.Pressure manometer site 3. Patient outlet Size of bag – 240 to 750 ml

Frequency of BM Ventilation 40 – 60 breaths per day Breath ----- two ----- three ----- breath Squeeze Release ---------------- Squeeze

When to Stop BM Ventilation Heart rate above 100/min Spontaneous breathing

Golden minute !!

CHEST COMPRESSIONS

CHEST COMPRESSIONS Indication Whenever HR remains <60 BPM despite 30 sec. of Effective PPV

CHEST COMPRESSIONS Position Lower third of the sternum Between nipple line and xiphisternum

Thumb Technique Correct Incorrect

CHEST COMPRESSIONS RATE 3 CC then 1 ventilation (1:3) 90 CC to 30 ventilation in one minute “ONE-AND-TWO-AND-THREE-AND- BREATHE AND” CC B&M

WHEN TO STOP CC When heart rate is 60 per minute or more

INDICATIONS FOR ET

Medications Indication: HR < 60 /min despite of 30 sec of chest compression & bag mask ventilation

Medications Adrenaline Recommended conc.: 1:10,000 Recommended route: intravenously Recommended dose: 0.1ml-0.3 ml/kg

Medications While access is being obtained, administration of a higher dose (0.05 to 0.1 mg/kg) through the endotracheal tube may be considered, but the safety and efficacy of this practice have not been evaluated

Volume Expansion Volume expansion should be considered when blood loss is known or suspected (pale skin, poor perfusion, weak pulse) and the baby’s heart rate has not responded adequately to other resuscitative measures. The recommended dose is 10mL/kg.

KEY MESSAGE All deliveries should be attended by a trained personnel Prevention of deaths related to perinatal asphyxia important for improving neonatal mortality in community Sequential and effective steps important for successful outcome

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