1. Neonatal Resuscitation
REFERENCES:
ILCOR Guidelines – 2005
WHO Regional Credentialing Program
Pacific EmOC Program

2. Objectives Identify of infants “at risk” for asphyxia
Discuss effects of asphyxia
Describe Resuscitation of newborn
Equipment
Bag and mask ventilation
Cardiac compressions
Post resuscitation care
Pacific EmOC Program

3. How many infants might require active resuscitation?
10% require some degree of active resuscitation
For up to 50% of this group there are no “risk factors”
Staff attending deliveries may be faced with an unexpectedly “flat” infant
Pacific EmOC Program

4. Antepartum Risks Maternal diabetes Chronic maternal illness
Cardiovascular
Thyroid
Neurological
Pulmonary
renal
Pre eclampsia
Maternal infection
Polyhydramnios
Oligohydramnios
Premature rupture of membranes
IUGR/preterm
Fetal malformation
Maternal substance abuse
No antenatal care
Post term gestation
Multiple gestation
Anaemia
Age <16 or > 35
Pacific EmOC Program

5. Intrapartum Risks Emergency CS Instrumental delivery Abnormal position
Premature labour
Precipitous labour
Chorioamnionitis
Prolonged rupture of membranes
Prolonged labour > 24 hrs
Prolonged 2nd stage of labour
Fetal bradycardia
Non-reassuring fetal heart rate pattern
General anaesthesia
Narcotics administered within 4 hours of delivery
Meconium stained liquor
Prolapsed cord
Abruptio placentae
Placenta previa
Pacific EmOC Program

6. Fetal asphyxia Primary apnoea Secondary Apnoeic Blue Heart rate 
Resuscitate easily
Secondary
apnoeic
White, floppy
Heart rate 
Blood pressure
Require active resuscitation eg IPPV to survive
Pacific EmOC Program

7. Always assume infant has secondary Apnoea & commence Resuscitation
Pacific EmOC Program

8. Equipment Needed for Resuscitation
Radiant warmer
Warm towel and blankets
Resuscitation bag and mask
Self inflating bag
Anaesthetic bag
Endotracheal tubes
Laryngoscope
Stethoscope
Oxygen source and tubing
Suction source and tubing
Drugs and fluids
Syringes, needles, cannulae, IV lines
+/-Umbilical lines
Pacific EmOC Program

9. ILCOR Guidelines for Neonatal Resuscitation 2005
Pacific EmOC Program

10. Steps in Resuscitation - ABCDE
Warmth and stimulation and assessment for the 1st 30 seconds
Use warm cloth
Replace when wet
Rapidly assess
Tone
Colour
Respiratory effort
Pacific EmOC Program

11. Steps in Resuscitation - ABCDE
Airway
Clear airway if required
Removal of secretions if present
Suction mouth and nose (only what you can see)
No more than 5cms for no longer than 5 secs
Negative pressure 100 mmHg (5litres)
DO NOT SUCTION IF AIRWAY IS CLEAR
Positioning
Supine or lateral
Head in neutral or slightly extended position
Pacific EmOC Program

12. Steps in Resuscitation - ABCDE
Breathing
Assessment of respiratory effort and colour
Indications for oxygen administration
Cyanosis
Respiratory distress
Give free flowing oxygen 5L/min
Pacific EmOC Program

13. Breathing: Indications for positive pressure ventilation
Apnoea
Gasping respiration
HR < 100 bpm
Persistent central cyanosis despite 100% O2
40-60 breaths/min
No response
Pacific EmOC Program

14. Steps in Resuscitation - ABCDE
Circulation
Assessment of heart rate and response to previous measures
Umbilical arteries
Apex beat
Auscultation
Pacific EmOC Program

15. Chest Compressions
HR < 60 bpm despite adequate vent with 100% O2 for 30 seconds
2 techniques
2 thumb (preferred)
2 finger
3:1 ratio
1/3 of AP diameter
Pacific EmOC Program

16. Steps in resuscitation - ABCDE
Drugs
Adrenaline
Volume Expanders
Naloxone
Pacific EmOC Program

17. Adrenaline
HR < 60 bpm after 30 seconds of adequate ventilation and chest compressions
mL kg of 1:10,000
Give via ETT, UVC, IV
Repeat dose if no response after 60 seconds
Pacific EmOC Program

18. Volume expanders Not given routinely Useful in hypovolemia
Suspected where there is a pale tachycardic infant
Normal saline
10mL/kg over 5-10 mins
UVC, IV
If haemorrhagic shock is suspected give whole blood or packed red cells
Pacific EmOC Program

19. Naloxone Narcotic antagonist Inadequate spontaneous respiratory effort
Mothers who received narcotics within 4 hrs of delivery
0.1mg/kg of a 0.4 mg/mL solution
ETT, IV, UVC, IM, SC
Monitor baby’s respirations for further respiratory depression
Pacific EmOC Program

20. Steps in resuscitation- ABCDE
Environment
Reduce draughts
Shut doors and windows
Turn on radiant warmer
Warm blankets/bunny rugs/hat/plastic wrap for pre terms
Pacific EmOC Program

21. Meconium liquor
ILCOR guidelines 2005 – no evidence to suction mouth and nose on perineum
If baby vigorous and crying - normal care & observation
If baby not vigorous – view cords and suction trachea under direct vision with laryngoscope & mec aspirator or wide bore catheter
Cease suctioning if return is clear or Heart Rate  60
Observe post resuscitation for signs of respiratory distress
Pacific EmOC Program