1. NEONATAL RESUSCITATION Rachel Musoke University of Nairobi KNH/UON SYMPOSIUM 10 TH Jan 2013

2. Poor intrapartum fetal oxygenation Also referred as asphyxia Common cause of death & long term disability (mental & neurological) Estimated to contribute to 9% of all < 5 mortality (MDG 4) Burden of disease assessment – 42 million disability-adjusted life years (DALYs)

3. Contributing factors The delays Delay in recognition of the problem in the mother Delay in transportation to a medical facility Delay in providing appropriate care at the health facility

4. Solutions to reduce deaths & disability Primary prevention – maternal care (early recognition & management) Secondary prevention – appropriate neonatal resuscitation Tertiary prevention – recognition & management of acute complications

5. The Global Need for neonatal Resuscitation, FIGO, Wall et al

6. Which babies need resuscitation? Assess: Gestation – term or preterm? Breathing or Crying? Good tone? If NO then act quickly – The first “golden minute”

7. The ABC of resuscitation Airway (Position and clear) Breathing (stimulate to breathe) Circulation (Majority of babies have normal hearts) Warmth

8. Breathing Ventilation of baby’s lungs is the most important and effective action in neonatal resuscitation

9. Room air vs.O 2 for Resuscitation Term Infants Pre-Term Infants (< 32 weeks)

10. Room air or oxygen? Term infants: Mortality lower with room air vs 100% O 2 Shorter recovery Preterm Balance the needs for oxygen vs possible toxicity

11. Oxygen saturations at birth 1 minute60-65% 2 minutes65-70% 3 minutes70-75% 4 minutes75-80% 5 minutes80-85% 10 minutes85-95%

12. Meconium stained liquor Clear mouth & nose before drying & stimulation to avoid aspiration Suctioning of the trachea reserved for nonvigorous babies

13. Equipments Warmth towels & heater Airway – suction catheters Ventilate – bag (500ml). & masks (sizes) Source of oxygen (& blender) Auscultate – stethoscope Pulse oximeter (if possible) Intubation equipment

14. Key behavior skills Know your environment Anticipate & plan Call for help & work as a team The person present must initiate resuscitation Communicate effectively Use all available resources

15. SUMMARY

16. Effective Resuscitation Airway & Breathing Circulation Drugs

17. Summary Everybody who conducts a delivery must be able to resuscitate We should be prepared at all times Lets give our newborn a good start