NEWBORN RESUSCITATION Belen Amparo E. Velasco, M.D.

TEMPERATURE (warm and dry) ABC’s AIRWAY (position and suction) BREATHING (stimulate to cry) CIRCULATION (heart rate and color ASSESS AND SUPPORT

INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

PREPARATION ADVANCED PREPARATION IMMEDIATE PREPARATION

ADVANCED PREPARATION OBSTETRICAL TRAY NB RESUSCITATION TRAY RADIANT WARMER/DROPLIGHT

NB RESUSCITATION EQUIPMENT Bulb syringe Endotracheal tube (2.5, 3.0, 3.5) and stylets Face masks and ambubag Feeding tubes Gowns, gloves, goggles Heat source Laryngoscope handles and blades Meconium aspirator Medications and fluids Sterile UC set Suction with manometer/catheters Syringes (1, 3, 10 and 20 ml) Warmed blankets

IMMEDIATE PREPARATION BASED ON RESUSCITATION -ORIENTED HISTORY VERIFICATION OF AIRWAY PATENCY AND PLACEMENT OF VASCULAR CATHETERS

RESUSCITATION- ORIENTED HISTORY MECONIUM STAINING PREMATURITY TWIN PREGNANCY NARCOTICS ADMINISTRATION TO MOTHER

FACTORS ASSOCIATED WITH INCREASED RISK FOR NEONATAL DEPRESSION ANTEPARTUM MATERNAL FACTORS INTRAPARTUM MATERNAL OR FETAL FACTORS

ANTEPARTUM MATERNAL FACTORS Maternal age > 35 or < 18 Chronic and pregnancy-induced HPN Diabetes Hemorrhage Drug therapy (Mg, lithium, adrenergic-blockers Substance abuse Previous abortion No prenatal care Anemia or isoimmunization

ANTEPARTUM MATERNAL FACTORS Maternal illness (CV, thyroid, neurologic) Multifetal gestation Small fetus for maternal dates Post-term fetus Preterm labor or PROM Immature pulmonary studies Oligohydramnios Diminished fetal activity Fetal malformation by UTZ

INTRAPARTUM MATERNAL OR FETAL FACTORS Breech or other abnormal presentation Infection Prolonged labor Prolonged rupture of membranes Prolapsed cord Maternal sedation Operative delivery Meconium-stained AF Indices of fetal distress

UNIVERSAL PRECAUTIONS GLOVES AND OTHER APPROPRIATE PROTECTIVE BARRIERS (gowns and goggles) SUCTION EQUIPMENT SHOULD ALWAYS BE AVAILABLE

INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

INITIAL STEPS OF RESUSCITATION (20 seconds) PREVENTION OF HEAT LOSS PROPER POSITIONING SUCTIONING TACTILE STIMULATION

TEMPERATURE REGULATION HEAT LOSS MAY BE PREVENTED BY REMOVING WET LINENS DRYING THE BABY PLACING INFANT UNDER PREHEATED LAMP/RADIANT WARMER

TEMPERATURE REGULATION ALTERNATIVE METHODS OF WARMING: WARM BLANKETS/TOWELS WARM MATTRESSES

AIRWAY POSITIONING PLACEMENT ON BACK OR SIDE WITH NECK IN NEUTRAL POSITION SHOULDER ROLL (3/4 OR 1 inch) to EXTEND NECK SLIGHLY

AIRWAY SUCTIONING IF MECONIUM-STAINED, TRACHEAL SUCTIONING BULB SYRINGE SHOULD BE ADEQUATE IF NOT MECONIUM-STAINED, SUCTION MOUTH FIRST THEN NOSTRILS

AIRWAY SUCTIONING MAY USE MECHANICAL SUCTION WITH 8F OR 10F SUCTION CATHETERS AT NEGATIVE PRESSURE NOT TO EXCEED -100mmHg FOR NO LONGER THAN 3 to 5 seconds PER ATTEMPT

TACTILE STIMULATION SLAPPING OR FLICKING THE SOLES GENTLE RUBBING OF THE BACK

ASSESSMENT RESPIRATORY EFFORT HEART RATE COLOR

INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

OXYGEN 100% OXYGEN SHOULD BE USED PREFERABLY WARMED AND HUMIDIFIED FREE-FLOW O2 BY O2 HOOD OR BY FACE MASK ATTACHED TO AMBUBAG OR SIMPLE MASK HELD TO FACE WITH 5L/min O2 FLOW

INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

POSITIVE-PRESSURE VENTILATION INDICATIONS APNEA OR GASPING RESPIRATION HEART RATE LESS THAN 100 bpm PERSISTENT CENTRAL CYANOSIS 100% OXYGEN

POSITIVE-PRESSURE VENTILATION USUALLY PROVIDED WITH BAG AND MASK VENTILATORY RATE of 40-60/min

INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

CHEST COMPRESSION INDICATIONS Persistent bradycardia (60- 80/min not increasing) despite 30 seconds of positive pressure ventilation

CHEST COMPRESSION CHEST COMPRESSION AT A RATIO with BAGGING OF 1:3 (Total of 120 events) TWO METHODS: Thumb method Two-finger method

INVERTED PYRAMID In NB Resuscitation Dry, Warm, Position, Suction, Stimulate Oxygen Establish effective ventilation Chest Compression Medications

MEDICATIONS EPINEPHRINE INDICATIONS Heart rate of zero Persistent bradycardia (<60/min) despite 30 seconds of positive pressure ventilation and 30 seconds of chest compression

MEDICATIONS VOLUME EXPANDERS INDICATIONS Acute blood loss Non-improvement despite adequate resuscitation

MEDICATIONS SODIUM BICARBONATE INDICATIONS Documented metabolic acidosis Cardiac arrest

MEDICATIONS NALOXONE INDICATIONS Respiratory depression with maternal history of narcotic intake within four hours from the time of delivery