1. BAG & MASK VENTILATION

2. Indications
Apneic or gasping following initial steps and tactile stimuloation
HR<100/min in a spontaneously breathing baby
Spontaneously breathing infant - cyanotic despite free flow oxygen

3. Contraindications Diaphragmatic hernia
Non -vigorous baby born through meconium stained liquor

4. Selecting bag & mask equipment
Size of bag ( ml): To deliver a tidal volume of 6-8 ml/kg
Oxygen capability: Oxygen source, reservoir
Safety feature: Pop off valve, pressure gauge (optional)
Mask: Size 0 & 1 (Cover chin, mouth, nose), cushioned edges

5. Forming seal
Positioning the infant
Position of resuscitator

6. Forming & checking the seal
Positioning & holding the mask: Enclose chin, mouth & nose, ensure snug seal, avoid pressure over neck and eyes
Squeeze the bag with finger tips: Don’t squeeze empty the bag with whole hand
Observe chest movements: Noticeable rise and fall of chest, shallow and easy breathing

7. Ventilation rate and pressure
Rate : breaths/minute
Squeeze-two-three-squeeze
Pressure : Increase in HR &/or Noticeable rise and fall of chest
Initial breath: cms H2O
Later : cms H2O

8. Improvement
Increasing HR
Improving color
Spontaneous breathing

9. No improvement / deterioration
Chest movement not adequate
Inadequate seal
Reapply mask
Blocked airway
Reposition
Clear secretions
Ventilate with open mouth
Insufficient pressure
Increasing pressure

10. Deterioration
Check oxygen delivery system
Oxygen supply
Oxygen tubing

11. Orogastric catheter Indication Technique
Need for bag and mask ventilation for over 2 minutes
Technique
Use 6-8 Fr size, measure the length, aspirate gastric contents, leave outer end open

12. Preterm infants
Avoid excessive chest wall movements (large tidal volume)
Monitoring of pressure may help to provide consistent inflations and avoiding unnecessary high pressure
CPAP after resuscitation may be helpful

13. Baby needs Bag and mask ventilation
Select bag and connect to oxygen source
capable of giving 100% oxygen
Select appropriate size mask
Test bag
Good pressure
Pressure release valve working
Pressure manometer cm H2O
Baby needs Bag and mask ventilation
Position yourself at head end or side of baby
Position baby’s head in sniffing position
Position bag and mask properly on baby
Check easy chest rise during first two-three breaths

14. Bag and mask ventilation
Yes No
Check for inadequate seal; reapply face mask
Chest Rise
Check for blocked airway.
Reposition head, remove secretions, mouth slightly open
Consider insufficient pressure. Increase pressure; consider intubation

15. Check heart rate with stethoscope or umbilical palpation for 6 seconds
Ventilate for 30 seconds
Rate bpm
Increasing HR, visible rise and fall of chest
Check heart rate with stethoscope or umbilical palpation for 6 seconds
Less than 6 beats
(< 60bpm)
6-10 beats
(60-100bpm)
More than 10 beats
(>100 bpm)
Continue ventilation
Initiate chest compression
Consider intubation
Continue ventilation
Consider intubation
Check for
spontaneous
breathing
Yes No
Gradually discontinue
positive pressure ventilation
Provide tactile stimulation
Provide free flow oxygen
Need of post-resuscitation care
Continue positive pressure ventilation
Consider intubation
Consider OG tube insertion
Need of post-resuscitation care