Neonatal Resuscitation -BLS- RC 290

Equipment Needed Overhead radiant warmer Bulb syringe BVM with heated & humidified O2 De Lee suction device Size 5 Fr suction catheters and wall suction Laryngoscope with proper sized blades Proper sized ET tubes Crash cart/Drug box

Normal Delivery Procedures Place under warmer and towel dry Use bulb syringe to clear mouth, than nose Tactile stimulation if not breathing yet Auscultate heart and lungs & assess color Prophylactic silver nitrate or erythromycin drops in eyes Vitamin K injection Examine umbilical cord Free flow O2 as needed

Free Flow O2 Hold O2 connecting tubing ½ inch from infants face. Run flow at 5 LPM

Resuscitation Maternal causes: –Drugs –Cardiopulmonary problems –Infection –Dystocia –Utero-Placental problems Fetal Causes –Cord compression –Prematurity –Congenital anomalies –Multiple pregnancy –Meconium aspiration –Hypothermia –shock

NRP Resuscitation Algorithm

Meconium Baby Airway is aggressively cleared prior to drying if infant is meconium stained AND baby is NOT vigorous! –Use ET tube as a suction device May need PD & P after heart rate, respirations, and color stabilize If baby is meconium stained but vigorous, proceed with normal resuscitation

Bagging a Neonate

BVM Devices

Flow-dependent anesthesia bag

Bagging Technique Place infant in “sniffing” position by placing a small towel under the shoulders Do not hyperextend neck!

Bagging technique ( cont.) Apply correctly sized mask over infants mouth and nose with apex of mask over bridge of nose

Run either type of bag at 5-8 LPM to get 100% FIO2 –If self-inflating bag, use reservoir also Watch for slight rise of chest (Vt ~ ml) Rate is Pressure –First breath may require cmH2O –Then, with normal lungs, cmH2O –Poor lung compliance may require sustained cmH2O

If BVM ventilation lasts over 2 minutes… Than an orogastric tube has to be inserted

Neonatal PD & P Meconium babies and/or C section babies No more than 20 degrees of Trendelenberg or ICP will increase Percuss anterior and lateral surfaces 1-2 minutes Maintain airway throughout using one hand on head Suction PRN Besides suction, need BVM and O2 Monitor heart rate, respirations and color throughout

Neonatal PD & P Percussors

Neonatal Chest Compressions Asystole or bradycardia less than 60 that is not increasing with airway and ventilation Use thumbs on lower half of sternum (one finger’s width below nipple line) Compress ½ to ¾ of an inch, 120 times per minute Compression ventilation ratio is 3:1 (pause to give breath)

The End Result