1. AIRWAY MANAGEMENT- NEONATES (Neonatal Resuscitation)
CHAKAFA N K
(Clinical Anaesthetist)

2. Introduction
At least 10% of all newborns require some assistance at birth ie the initial steps of resuscitation
And 1% require extensive resuscitation
There are 1 million deaths per year resulting from Birth asphyxia(WHO,1995)
A significant number will have respiratory problems and a large number will have seizures and later problems such as cerebral palsy.

3. Definitions Airway mgt is a process of ensuring that
there is an open pathway between patient’s lungs and the outside world
The lungs are safe from aspiration.
Neonate – baby less than 28 days

4. Neonates compared to older children
Neonates are small
Large surface area to weight ratio
Born wet so they are prone to rapid evaporative heat loss
New born babies are in transition from placental to pulmonary respiration
Large tongue
Proportionally large head and occiput

5. Essential equipment for resuscitation of the newborn
Firm flat padded resuscitation surface
Source of warmth( overhead heater, warm dry towels,radiator,hot water bottle wrapped in towels.
Clear plastic bags for preterm babies under 30wks
Good light source
Clock or timer to record time of birth, assessment and response to resuscitation
Airway equipment: facemask 0 and 1,oropharyngeal airway size 000,00 and 0, self inflating bag with reservoir, neonatal face masks, laryngoscope and blade with spare bulb Miller (1,0), Mackintosh blade(1,0) , tracheal tubes (2.5 ,3 for pre term and 3.5 or 4 for term, stylets, size 1 LMA

6. Equipment cont’d Nasogastric tube Adhesive tape Oxygen
Stethoscope to assess HR and breath sounds
IV cannulae, 24 g, umblical catheter
Drugs : N/saline, adrenaline 1:10000,10% glucose, sodium bicarbonate,naloxone

7. Assessment
Was th e baby born after full term gestation? Is the amniotic fluid clearof meconium and evidence of infection? Is the baby crying? Does the baby have a good muscle tone?

9. Healthy child
If the answer to all 4 of these questions is “yes” then there is no need for any resuscitation
Do not separate the child from the mother
Dry the baby, place onto the mother’s chest
Cover the child with a dry cloth
Observation of breathing , activity and colour should be ongoing

11. Asphyxiated baby
If the answer is “no” then the child is in danger, so the child should receive one or more of the following :
Initial steps in stabilization(provide warmth, position, clear airway, dry, reposition)
Ventilation
Chest compressions
Administration of epinephrine and /or volume expansion

12. Heat Loss Minimise heat loss especially in pre term babies
Warm towels, dry the child as soon as possible
Change towels
Place the child under a radiant heater
This must be done in 20 – 30 seconds

13. Airway
Maintain head in neutral position with face parallel to the surface on which the baby is lying
Avoid overextension/ flexion of the neck
Provide a jaw thrust
Oropharyngeal airway may be helpful- large tongue

14. Meconium aspiration Some babies may pass meconium in utero
Inhalation of meconium before birth or during birth can cause severe pneumonitis.
Remove any thick particulate by means of a large bore suction device or a penguin
Do not suction the nose before the mouth- this will stimulate the baby to gasp and to aspirate pharyngeal secretions
Intubation is necessary in a floppy child.

15. Ventilation Ventilate the lungs with either room air or 100% oxygen
Well fitting mask to the nose and mouth
Inflate the lungs with at a pressure of around 30cm of water
Aim at inspiratory time of 2-3secs
Give at least 5 inflations

16. Circulation Re evaluate HR
If HR is above 100 then it’s a firm indication that lungs are adequately aerated
Assess chest movement
If HR has not improved ---- START CHEST COMPRESSIONS

17. Chest compressions
Indicated for a HR that is less than 60 despite adequate ventilation
Necessary to bring oxygenated blood from the lungs back to the coronary arteries
Both hands encircling the chest
Place thumbs together centrally over the lower sternum
Rate- 120/min
For every 3 compressions give one breath aiming at 40 breaths/min

19. Assessment Look for response after 30-60secs of chest compressions
If HR is above 100 then it indicates that you are succeeding
However if the HR has not improved or is absent then consider DRUGS

20. Drugs Epinephrine 1:10000 0.1-0.3ml/kg IV
Epinephrine 1: ml/kg per ET
Give ET only while IV access is being established
Repeat every 5 minutes
Caution- higher doses in newborns may result in brain and heart damage.
Sodium bircabonate (4,2% soln) 2mEq/kg IV over 2 min if severe metabolic acidosis is suspected

21. Post resuscitation care
Glucose – 10% dextrose water 2ml/kg iv
Phenobarbital (seizures) 20mg/kg slow iv
Dopamine(hypotesion) mcg/kg

22. Discontinuing Resuscitative Efforts
Infants without signs of life i.e. no heart beat and no respiratory effort after 10min of resuscitation

23. THANK YOU FOR YOUR TIME