Newborn care and resuscitation June 24, 2014 Michael Kim, MD Newborn care and resuscitation 2014 Emergency Care Trauma Symposium June 24, 2014 Michael Kim, MD

Topics Preparation Initial assessment Initial intervention and intervention HR dependent interventions Timing and use of O2 Use of pulse oximetry Advanced care

Kattwinkel J et al. Circulation 2010;122:S909-S919 Copyright © American Heart Association

Preparation Gestational age Multiple? Pregnancy complications Provider assignment Equipments – Warm towels – Mask, Bag, O2, Suction – Plastic wrap – Oxygen – Proper sized Laryngoscope, blade, ETT, (RT) – EZ IO – Medication – Advanced support

Initial assessment Crying Breathing Tone

Term, good cry and tone Stay with mom, keep warm and transport

If not Warm, dry, and stimulate Clear airway with suction bulb/catheter Monitor and maintain temperature

If vigorous, support only If not vigorous,  Suction mouth and nose  Endotracheal suction before PPV Vigorous or not so vigorous?

Assessment of O2 need/administration Birth cyanosis: up to 10 min Excess and/or deficit are harmful POX: only when sustained resuscitation is anticipated

Assessment of O2 need/administration PPV and O2 administration – Goal: achieve target saturation/HR – Start with RA or blended O2 – PPV if apnic, gasping or HR<100 – increase O2 if HR < 60 after 90 sec of intervention

Definitive airway Endotracheal Intubation: – Initial suctioning of depressed meconium stained baby – BMV is ineffective – Chest compression is needed Laryngeal Mask Airway: if mask or ETT unsuccessful

Chest compressions Indicated if HR < 60 after 30 sec of ventilation with O2 1/3 AP diameter on lower 1/3 of sternum 2 thumbs encircling the chest 2 finger method: not ideal 90 compressions/ min (3:1)

Vascular access

Medications Epinephrine if – HR < 60 with adequate ventilation, 100% O2, and Chest compression – IV: mg/kg (1:10,000) – ET: mg/kg (1:10,000)

Approach Airway Breathing Circulation Dextrose Environment

Approach Airway Breathing Circulation Dextrose (Don’t Ever Forget the Glucose) Environment

Newborn care algorithm Initial evaluationTerm, cry, breathing, tone (Pox/perfusion not reliable) FactorsResp effort, HR, tone, time (POx: later) Initial interventionWarm, dry, sxn, stim CPAP indicationIf resp distress with HR>100 PPV indicationif gasping, apnic or HR<100 Oxygen indicationIf HR<60 after PPV x 90sec Compression indicationIf HR<60 after PPV with O2 x 30 sec IV Epi dose mg/kg (1:10,000) ET Epi dose mg/kg (1:10,000) Vascular accessUmbilical catheter

Summary Preparation Crying, breathing and tone Warm, dry and stimulate Pulse Ox reading misleading ABCDEFG