1. Dr. Muhammad Zahoor ul Haq Assistant Professor of Paediatrics RMC Rawalpindi

2. Neonatal Resuscitation

3. Neonatal Resuscitation
Resuscitation is active intervention to establish normal cardio respiratory function
5-10% require active intervention

4. Goal
To prevent morbidity & mortality associated with hypoxic ischemic tissue (brain, heart, kidney) injury
Anticipate high risk situations

5. Guideline for neonatal resuscitation
Guideline for neonatal resuscitation Integrated assessment / response approach for initial evaluation of an infant Color - General appearance - Risk factor

6. Fundamental Principles. - Evaluation of airway
Fundamental Principles - Evaluation of airway - Establishing effective respiration - Establishing adequate circulation

7. Immediate Care. - Place under radiant heater. - Dry
Immediate Care - Place under radiant heater - Dry - Position (head down & slightly extended) - Clear airway - Gentle tectile stimulation

8. Assess - Infant’s color - Heart rate

9. Evaluate respirations
Approximate
time
The Fetus and Neonatal Infant
BIRTH
Routine care
. Provide warmth
. Clear airway if needed
. Dry
. Assess color
30 Seconds
Term gestation?
Amniotic fluid clear?
Breathing or crying?
Good muscle tone?
Yes
Provide warmth
Position; clear airway*
(as necessary)
Dry, stimulate, reposition
Breathing HR> & Pnk
Observational Care
Evaluate respirations
Heart rate, and color

10. Give supplementary Oxygen
Breathing HR> & Pnk
Evaluate respirations
Heart reate, and color
Observational Care
Breathing HR>100 but Cyanotic
Pink
Give supplementary Oxygen
30 Seconds
Apnea or HR <100
Effective Ventilation HR>100 & pink
Persistent Cyanosis B
Postresuscitation Care
Provide positive –pressure ventilation
HR<60
HR>60 C
30 Seconds
Provide positive pressure ventilation
Administer chest compression
HR<60 D
Administer epinephrine and or volume*

11. Give supplementary Oxygen
Approximate
time
The Fetus and Neonatal Infant
BIRTH
Term gestation?
Amniotic fluid clear?
Breathing or crying?
Good muscle tone?
Routine care
. Provide warmth
. Clear airway if needed
. Dry
. Assess color
Yes No A
Provide warmth
Position; clear airway*
(as necessary)
Dry, stimulate, reposition
30 Seconds
Breathing HR> & Pink
Evaluate respirations
Heart rate, and color
Observational Care
Breathing HR>100 but Cyanotic
30 Seconds
Apnea or HR <100
Pink
Give supplementary Oxygen
Effective Ventilation HR>100 & pink B
Persistent Cyanosis
Provide positive –pressure ventilation
Postresuscitation Care C
HR<60
HR>60
30 Seconds
Provide positive pressure ventilation
Administer chest compression D
HR<60
Administer epinephrine and or volume*

12. Respiratory Effort. Steps. Follow ABCs. A-. Anticepate & establish. B-
Respiratory Effort Steps Follow ABCs A- Anticepate & establish B- Initiate Breathing C- Maintain Circulation D- Drugs

13. If no respiration or heart rate below 100/min
If no respiration or heart rate below 100/min - Give positive pressure with face mask Endotracheal intubation

14. If heart does not improve then:. - Start chest compression. - Site
If heart does not improve then: - Start chest compression - Site Lower third of sternum :1

15. If no improvement give epinephrine

16. Poor response to Ventilation. - Loosely fitted mask
Poor response to Ventilation Loosely fitted mask - Poor position of ETT - Intraesophageal intubation - Airway Obstruction - Insufficient pressure - Excess Air in Stomach

17. Administration of Naloxone Hydrochloride. Ind:
Administration of Naloxone Hydrochloride Ind: - Respiratory depression - Mother has H/O narcotic - Drug administration Dose:- 0.1mg/kg ½, intratracheal

18. Emergency Volume Expander. - Isotonic crystalloid solution. 10-20ml/kg
Emergency Volume Expander - Isotonic crystalloid solution ml/kg - O -ve blood

19. Sodium Bicarbonate. - Indication. - Documented metabolic acidosis
Sodium Bicarbonate - Indication Documented metabolic acidosis Prolong resuscitation - Dose - 2meq/kg ½

20. Dopamine or Dobutamine Ind: - Cardiogenic shock - Dose 5-20mg/kg/min

21. Infusion Epinephrine. Ind:. - Unresponsive Cardiac shock. Dose:. - 0
Infusion Epinephrine Ind: - Unresponsive Cardiac shock Dose: mg/kg/min

22. Primary Apnea. →Asphyxia →Reduce
Primary Apnea →Asphyxia →Reduce Heart rate → apnea Immediate Intervention - Oxygen inhalation - Tectile stimulation

23. Secondary Apnea. - Gasping respiration. - Bradycardia. - Hypotension
Secondary Apnea - Gasping respiration - Bradycardia - Hypotension - Finally apnea Immediate Intervention - Positive pressure ventilation

24. Equipment Required. - Resuscitation table. - Sterile Linen
Equipment Required - Resuscitation table - Sterile Linen - Suction apparatus ( Catheter 5, 6, 8) - Laryngoscope with straight blade - Ambo bag with face mask - Endotracheal tube - Gloves

25. Medications. - Epinephrine 1:10,000. - Naloxone hydrochloride
Medications - Epinephrine 1:10, Naloxone hydrochloride - Volume expander - Soda bicarbonate % Dextrose water - Sterile water

26. Miscellaneous. - Radiant warmer. - Stethoscope. - Adhesive tape
Miscellaneous - Radiant warmer - Stethoscope - Adhesive tape - Syringes - Butterfly needle - Umbilical artery - Catheterization tray

27. Indication for Endotracheal tube. Intubation
Indication for Endotracheal tube Intubation - Ineffective bag & mask ventilation - Prolong PPV required - Suspicion of diaphragmatic hernia -Preterm infant -Meconium aspiration

28. Stop Resuscitation
If no respiratory & cardiac activity after 20 min of resuscitation
Fixed pupil

29. Thank You