1. Resuscitation of the newborn baby

2. Learning objectives To assess a newborn baby at birth
To perform basic resuscitation of a newborn baby using standard equipment
Resuscitation in special situations: meconium stained liquor and preterm birth
To learn principles of aftercare for a baby who requires resuscitation at birth
NH- 2
Teaching Aids: ENC

3. Resuscitation: Key words
Anticipation
Preparation
Help
Record
Fast
Gentle
Warmth
Hygiene
Mother
NH- 3
Teaching Aids: ENC

4. Check if all equipments are in working order
Preparing for birth
Wash your hands
Draught free, warm room - temperature >250C
Clean, dry and warm delivery surface
Radiant heater
Two clean, warm towels/clothes
A folded piece of cloth
Self inflating bag - newborn size
Infant masks in two sizes - normal and small newborn
Suction device
Oxygen (if available)
Clock
Check if all equipments are in working order
NH- 4
Teaching Aids: ENC

5. Assessment at birth Assess breathing while drying
Deliver the baby on to mother’s abdomen
Note and call out time of birth
Thoroughly dry the baby
Use a warm towel
Discard wet towel after drying
Wrap the baby in another warm cloth
Keep the baby warm
Assess breathing while drying
NH- 5
Teaching Aids: ENC

6. Care of the baby at birth
Assess breathing:
Assessment
Decision
Baby is crying
No need for resuscitation or suctioning;
Start skin-to-skin contact and breastfeeding
Baby is not crying, but breathing at 30 to 60 times per minute
No need for resuscitation or suctioning
Baby is gasping
Start resuscitation immediately
Baby is not breathing
NH- 6
Teaching Aids: ENC

7. Scenario 1
A mother arrived at your maternity hospital and delivered a baby girl as soon as she reached the labor ward. The placenta followed the baby and mother was not bleeding.
The baby was pale. He was breathing and heart rate was 120/min.
What is the Action?
NH- 7
Teaching Aids: ENC

8. Dry the baby immediately after birth
NH- 8
Teaching Aids: ENC

9. Immediate skin-to-skin Contact & Breastfeeding (routine care) NH- 9
Teaching Aids: ENC

10. Message 1
ONLY Routine care is required for a baby who is crying or breathing normally;
Even routine suctioning is not required for these normal babies
NH- 10
Teaching Aids: ENC 10

11. Scenario 2
A baby girl is born at your clinic after second stage of 60 minutes. The umbilical cord is short.
You see that the skin is pale .She is not breathing. Heart rate is over 100/min.
What is the Action?
NH- 11
Teaching Aids: ENC

12. Steps of resuscitation
If the baby is not breathing or gasping
Call for help!
Cut cord quickly, transfer to a firm, warm surface [under a radiant heater]
Inform the mother that baby has difficulty breathing and you will help the baby to breathe
Start newborn resuscitation
NH- 12
Teaching Aids: ENC

13. Position, clear airways
Steps of resuscitation
Position, clear airways
NH- 13
Teaching Aids: ENC

14. Position, clear airways
Steps of resuscitation
Position, clear airways √
NH- 14
Teaching Aids: ENC

15. Suction: Do not exceed duration of 20 sec
Steps of resuscitation
Position, clear airways (if needed)
Suction: Do not exceed duration of 20 sec
NH- 15
Teaching Aids: ENC

16. Steps of resuscitation
Dry, stimulate, reposition
NH- 16
Teaching Aids: ENC

17. Steps of resuscitation
Dry, stimulate, reposition
NH- 17
Teaching Aids: ENC

18. Steps of resuscitation
Dry, stimulate, reposition
NH- 18
Teaching Aids: ENC

19. Steps of resuscitation
Ventilate (if still not breathing)
Selecting Bag & Mask equipment
Size of bag: ml
Oxygen capability: Oxygen source, reservoir
Safety feature: Pop off valve, pressure gauge (optional)
NH- 19
Teaching Aids: ENC

20. Steps of resuscitation
Ventilate
Use the CORRECT size face mask that covers:
The nose
The mouth
The tip of the chin
but not the eyes
NH- 20
Teaching Aids: ENC

21. Steps of resuscitation
Fitting a face mask:
A face mask that is too LARGE
Covers the eyes
Extends over the tip of the chin
A face mask that is too SMALL
Does not cover the nose
Does not cover the mouth effectively
NH- 21
Teaching Aids: ENC

22. Steps of resuscitation
Ventilate
Squeeze bag with 2 fingers or whole hand, 2-3 times
Observe for rise of chest
IF CHEST IS NOT RISING:
Check seal
Reposition the head
Squeeze harder
Once good seal and chest rising, ventilate at 40 squeezes per minute
Observe chest rise
Check heart rate after 30 seconds
NH- 22
Teaching Aids: ENC

23. Message 2
Bag and mask ventilation is required for a baby NOT BREATHING or GASPING
NH- 23
Teaching Aids: ENC 23

24. Steps of resuscitation
When to stop ventilating?
If baby is crying;
If breathing >30/min, and
NO chest in-drawing:
If the skin between the ribs is ‘sucked’ inwards and the ribs are prominent, the baby has chest ‘in-drawing’
NH- 24
Teaching Aids: ENC

25. Steps of resuscitation
After stopping ventilation
Put the baby in skin-to-skin contact on mother’s chest
Monitor every 15 minutes for breathing and warmth
Tell the mother the baby will probably be well
Encourage the mother to start breastfeeding as soon as possible
NEVER leave the baby alone
NH- 25
Teaching Aids: ENC

26. Steps of resuscitation
When to continue ventilating?
If the baby
is breathing at a rate of <30/min,
is gasping
has severe chest in-drawing
Arrange for immediate referral
NH- 26
Teaching Aids: ENC

27. Steps of resuscitation
Referral
Explain to the mother what happened, that her baby needs help with breathing
Ventilate during the referral
Record the event on a referral form and labour record
If the baby is NOT breathing even after 20 minutes, STOP ventilating
NH- 27
Teaching Aids: ENC

28. Scenario 3
Baby girl born at 38 weeks following thick meconium stained amniotic fluid is noted to be limp and not breathing .
The baby is blue. She was not breathing and heart rate was 80/min.
What is the Action?
NH- 28
Teaching Aids: ENC

29. No need for intrapartum suction Nonvigorous: any parameter abnormal
Birth: assess
HR, breathing and tone
Vigorous: HR>100
good breathing
Good tone
Nonvigorous: any parameter abnormal
Initial steps
Tracheal suction
NH- 29
Teaching Aids: ENC

30. Message 3 Meconium stained depressed baby needs
endotracheal suction prior to B&MV
Routine suction of oro-pharynx is not recommended before delivery of shoulder
NH- 30
Teaching Aids: ENC 30

31. Scenario 4
Mother admitted in maternity unit delivered a baby boy at 32 week gestation on bed. The baby is limp and not breathing.
The baby is pale. He is not breathing and HR is 80/min.
What is the Action?
NH- 31
Teaching Aids: ENC

32. Steps of resuscitation
Special considerations for preterm
Be gentle
Use small size resuscitation bag and give small tidal volumes to move chest
Avoid 100% oxygen , use blenders and oxygen saturation monitors
Avoid rapid fluid bolus
May need intubation, chest compression, medications
Keep CPAP back up ready
NH- 32
Teaching Aids: ENC 32

33. Message 4
Preterm births need special precautions before and during resuscitation
NH- 33
Teaching Aids: ENC 33

34. Post resuscitation management
Principles
Keeping normal temperature
Maintaining oxygenation
Maintaining physiological milieu- fluids , glucose
Maintaining perfusion
Treating seizures
Monitoring organ function
NH- 34
Teaching Aids: ENC 34

35. Care after resuscitation
Place baby in skin-to-skin contact with mother
Keep the baby warm
Monitor every 15 minutes
Start breastfeeding as soon as possible
Discuss what has happened with the parents - be positive!
Do not separate the mother and baby unless the baby has difficult breathing
NH- 35
Teaching Aids: ENC

36. Summary: Steps of resuscitation
1. Keep the baby warm: Place under the radiant heater
2. Open the airway:
- Position baby’s head so it is slightly extended
- Suction the mouth and then the nose
3. If still not breathing: VENTILATE
4. If breathing or crying begins: STOP VENTILATION

37. Summary: Steps of resuscitation
5. If breathing at <30 breaths per minute or there is severe chest in-drawing: CONTINUE VENTILATION 6. If no breathing or gasping after 20 minutes of ventilation: STOP VENTILATION 7. Explain events to the mother and document