Newborn resuscitation: A 20 minute baptism of fire

Newborn resuscitation Why is resuscitation at birth different? Newborn Babies: Are wet so they get cold Have lungs that are unexpanded and full of fluid Take minutes for oxygen saturation to rise

Newborn transition Kamlin. J Ped minute: 63% (53-68) 5 minutes: 90% (79-91)

Newborn transition Video

Newborn resuscitation Why is resuscitation at birth different? Newborn Babies: Have a facility for agonal (spinal) gasping a “second chance” for ventilation Have hearts that have extra energy to keep going Have a convenient site for central vascular access

Newborn resuscitation Asphyxia in utero

Newborn resuscitation Why is resuscitation at birth different? Of the 280,078 live born infants in Australia in 2006: 61% required no intervention 16% received oxygen therapy 15% received suctioning 6% received bag-mask ventilation 0.7% received intubation and IPPV 0.2% received ECM AIHW (2008)

Newborn resuscitation Assessment Airway, Breathing and Circulation all assessed before and during resuscitation: Tone, Breathing, Heart Rate and Oxygenation

Newborn resuscitation Basic approach Maintain normothermia

Newborn resuscitation Basic approach Assess: tone, breathing, heart rate, oxygenation Maintain normothermia Breathing: inflation breaths; consider PEEP; consider O 2 Circulation: - chest compressions (2 thumb technique) - 3:1 ventilation:ECM - adrenaline via umbilical vein

Appx I p342/x Newborn life support algorithm Courtesy of the New Zealand Resuscitation Council and Australian Resuscitation Council

Assessment and airway

Breathing

Circulation

Translation of the evidence Survey of Australian and New Zealand maternity hospitals without NICU facilities in % of respondents were aware of ARC algorithm 91% advocated the use of blended oxygen 20% of hospitals had capacity to deliver blended oxygen 19% of hospitals had guidelines 38% used pulse oximeters at delivery Bhola J Paed Ch Health 2012

Newborn resuscitation Summary An approach to resuscitation of the newly born infant is addressed in the APLS course but cannot be adequately taught to equip candidates with the skills to translate the concepts into practice Emphasis should be on understanding the normal transition from fetus to newborn and a focus on the importance of providing breathing support when necessary, with strong reference to relevant guidelines

Newborn resuscitation Q&AQ&A