Dr. Muhammad Zahoor ul Haq Assistant Professor of Paediatrics RMC Rawalpindi

Neonatal Resuscitation

Neonatal Resuscitation Resuscitation is active intervention to establish normal cardio respiratory function 5-10% require active intervention

Goal To prevent morbidity & mortality associated with hypoxic ischemic tissue (brain, heart, kidney) injury Anticipate high risk situations

Guideline for neonatal resuscitation Guideline for neonatal resuscitation Integrated assessment / response approach for initial evaluation of an infant - Color - General appearance - Risk factor

Fundamental Principles. - Evaluation of airway Fundamental Principles - Evaluation of airway - Establishing effective respiration - Establishing adequate circulation

Immediate Care. - Place under radiant heater. - Dry Immediate Care - Place under radiant heater - Dry - Position (head down & slightly extended) - Clear airway - Gentle tectile stimulation

Assess - Infant’s color - Heart rate

Evaluate respirations Approximate time The Fetus and Neonatal Infant BIRTH Routine care . Provide warmth . Clear airway if needed . Dry . Assess color 30 Seconds Term gestation? Amniotic fluid clear? Breathing or crying? Good muscle tone? Yes Provide warmth Position; clear airway* (as necessary) Dry, stimulate, reposition Breathing HR>100 & Pnk Observational Care Evaluate respirations Heart rate, and color

Give supplementary Oxygen Breathing HR>100 & Pnk Evaluate respirations Heart reate, and color Observational Care Breathing HR>100 but Cyanotic Pink Give supplementary Oxygen 30 Seconds Apnea or HR <100 Effective Ventilation HR>100 & pink Persistent Cyanosis B Postresuscitation Care Provide positive –pressure ventilation HR<60 HR>60 C 30 Seconds Provide positive pressure ventilation Administer chest compression HR<60 D Administer epinephrine and or volume*

Give supplementary Oxygen Approximate time The Fetus and Neonatal Infant BIRTH Term gestation? Amniotic fluid clear? Breathing or crying? Good muscle tone? Routine care . Provide warmth . Clear airway if needed . Dry . Assess color Yes No A Provide warmth Position; clear airway* (as necessary) Dry, stimulate, reposition 30 Seconds Breathing HR> & Pink Evaluate respirations Heart rate, and color Observational Care Breathing HR>100 but Cyanotic 30 Seconds Apnea or HR <100 Pink Give supplementary Oxygen Effective Ventilation HR>100 & pink B Persistent Cyanosis Provide positive –pressure ventilation Postresuscitation Care C HR<60 HR>60 30 Seconds Provide positive pressure ventilation Administer chest compression D HR<60 Administer epinephrine and or volume*

Respiratory Effort. Steps. Follow ABCs. A-. Anticepate & establish. B- Respiratory Effort Steps Follow ABCs A- Anticepate & establish B- Initiate Breathing C- Maintain Circulation D- Drugs

If no respiration or heart rate below 100/min If no respiration or heart rate below 100/min - Give positive pressure with face mask - Endotracheal intubation

If heart does not improve then:. - Start chest compression. - Site If heart does not improve then: - Start chest compression - Site Lower third of sternum 3:1

If no improvement give epinephrine

Poor response to Ventilation. - Loosely fitted mask Poor response to Ventilation - Loosely fitted mask - Poor position of ETT - Intraesophageal intubation - Airway Obstruction - Insufficient pressure - Excess Air in Stomach

Administration of Naloxone Hydrochloride. Ind: Administration of Naloxone Hydrochloride Ind: - Respiratory depression - Mother has H/O narcotic - Drug administration Dose:- 0.1mg/kg ½, intratracheal

Emergency Volume Expander. - Isotonic crystalloid solution. 10-20ml/kg Emergency Volume Expander - Isotonic crystalloid solution 10-20ml/kg - O -ve blood

Sodium Bicarbonate. - Indication. - Documented metabolic acidosis Sodium Bicarbonate - Indication - Documented metabolic acidosis - Prolong resuscitation - Dose - 2meq/kg ½

Dopamine or Dobutamine Ind: - Cardiogenic shock - Dose 5-20mg/kg/min

Infusion Epinephrine. Ind:. - Unresponsive Cardiac shock. Dose:. - 0 Infusion Epinephrine Ind: - Unresponsive Cardiac shock Dose: - 0.1-1.0mg/kg/min

Primary Apnea. →Asphyxia →Reduce Primary Apnea →Asphyxia →Reduce Heart rate → apnea Immediate Intervention - Oxygen inhalation - Tectile stimulation

Secondary Apnea. - Gasping respiration. - Bradycardia. - Hypotension Secondary Apnea - Gasping respiration - Bradycardia - Hypotension - Finally apnea Immediate Intervention - Positive pressure ventilation

Equipment Required. - Resuscitation table. - Sterile Linen Equipment Required - Resuscitation table - Sterile Linen - Suction apparatus ( Catheter 5, 6, 8) - Laryngoscope with straight blade - Ambo bag with face mask - Endotracheal tube - Gloves

Medications. - Epinephrine 1:10,000. - Naloxone hydrochloride Medications - Epinephrine 1:10,000 - Naloxone hydrochloride - Volume expander - Soda bicarbonate - 10% Dextrose water - Sterile water

Miscellaneous. - Radiant warmer. - Stethoscope. - Adhesive tape Miscellaneous - Radiant warmer - Stethoscope - Adhesive tape - Syringes - Butterfly needle - Umbilical artery - Catheterization tray

Indication for Endotracheal tube. Intubation Indication for Endotracheal tube Intubation - Ineffective bag & mask ventilation - Prolong PPV required - Suspicion of diaphragmatic hernia -Preterm infant -Meconium aspiration

Stop Resuscitation If no respiratory & cardiac activity after 20 min of resuscitation Fixed pupil

Thank You