1. NEONATAL RESUSCITATION
Prof. Pradeep G.C.M
Consultant Neonatologist
M.S.Ramaiah Medical college
Bangalore

2. Why learn Neonatal Resuscitation?
Asphyxia - 19% of neonatal deaths
Resuscitation – can improve outcome of  1 million babies
10% babies require resuscitation
1% - extensive resuscitative measures

3. Myths in neonatal resuscitation

4. Myth 01
Resuscitation is done by “qualified pediatrician” only

5. Who should resuscitate?
At every delivery there should be at least 1
person whose primary responsibility is the
newly born
The person must be capable of initiating resuscitation, including administration of positive-pressure ventilation and chest compressions

6. Myth 02
Resuscitation is a complex process involving chest compressions / Intubation

8. Myth 03
Only high risk vaginal deliveries /LSCS require person for resuscitation

9. Risk factors
Birth asphyxia can be caused by events that happen in either the antepartum, the intrapartum, or the postpartum periods or combinations of above
Birth asphyxia could occur in deliveries without any known risk factors

10. Myth 04
We cannot resuscitate without oxygen !!

11. Room air resuscitation
In term infants requiring resuscitation room air resuscitation has shown to be as effective and better than 100% oxygen

12. Myth 05
Chest compressions and adrenaline is important along with ventilation of lung

13. Neonate’s first breaths

14. Cardiopulmonary adaptation

15. In-utero or perinatal compromise

16. Physiology of resuscitation
Ventilation of the lung is the most important step in neonatal resuscitation !!

17. Neonatal resuscitation

18. Steps for Successful resuscitation
Anticipation
Preparation
Prompt intervention

19. Preparation Warm labor room, radiant warmer Sterile gloves Warm linen
Check list for equipment
Working condition !!!

20. Check list Suction equipment Suction machine, suction catheters
Bag & mask equipment
Oxygen source, masks, reservoirs
Intubation equipment
laryngoscope, ET tube, stylet, tape
Medications
adrenaline, normal saline, syringes

21. Overview of NRP 2010

23. INITIAL ASSESSMENT

24. INITIAL ASSESSMENT
Action in sequence !!!

25. T - ABC
T – temperature
A – airway
B – breathing
C – circulation

26. Initial Steps Provide warmth Position clear airway
Dry, stimulate, reposition

27. Initial Steps Provide warmth Position clear airway
Dry, stimulate, reposition

28. Warmth “COLD” welcome Amniotic fluid 37 C Labor room - 20-28 C
Switch on 10 min before
3 pre-warmed towels
No draughts of air

29. Initial Steps Provide warmth Position clear airway
Dry, stimulate, reposition

30. Position

31. Correct Position

32. Position
To help maintain correct position, you may place a rolled blanket or towel under the shoulder

33. Initial Steps Provide warmth Position clear airway
Dry, stimulate, reposition

34. Clear airway

35. Clear airway

36. Initial Steps Provide warmth Position clear airway
Dry, stimulate, reposition

37. Dry

38. Stimulate Drying, suctioning 1-2 times Don’t waste time Don’t slap
Don’t shake

39. After initial steps

40. VENTILATION

41. Self Inflating Bag Size of bag – 240 to 750 ml 2. Oxygen inlet
7.Pressure manometer site
3. Patient outlet
Size of bag – 240 to 750 ml

42. Frequency of BM Ventilation
40 – 60 breaths per day
Breath two three breath
Squeeze
Release
Squeeze

43. When to Stop BM Ventilation
Heart rate above 100/min
Spontaneous breathing

44. Golden minute !!

45. CHEST COMPRESSIONS

46. CHEST COMPRESSIONS Indication
Whenever HR remains <60 BPM despite 30 sec. of Effective PPV

47. CHEST COMPRESSIONS Position Lower third of the sternum
Between nipple line and xiphisternum

48. Thumb Technique
Correct
Incorrect

49. CHEST COMPRESSIONS RATE 3 CC then 1 ventilation (1:3)
90 CC to 30 ventilation in one minute
“ONE-AND-TWO-AND-THREE-AND- BREATHE AND” CC
B&M

50. WHEN TO STOP CC
When heart rate is 60 per minute or more

51. INDICATIONS FOR ET

52. Medications Indication:
HR < 60 /min despite of 30 sec of chest compression & bag mask ventilation

53. Medications Adrenaline Recommended conc.: 1:10,000
Recommended route: intravenously
Recommended dose: 0.1ml-0.3 ml/kg

54. Medications
While access is being obtained, administration of a higher dose (0.05 to 0.1 mg/kg) through the endotracheal tube may be considered, but the safety and efficacy of this practice have not been evaluated

55. Volume Expansion
Volume expansion should be considered when blood loss is known or suspected (pale skin, poor perfusion, weak pulse) and the baby’s heart rate has not responded adequately to other resuscitative measures.
The recommended dose is 10mL/kg.

56. KEY MESSAGE All deliveries should be attended by a trained personnel
Prevention of deaths related to perinatal asphyxia important for improving neonatal mortality in community
Sequential and effective steps important for successful outcome

57. THANK YOU !!!