Post on 10-Nov-2015
NEONATAL RESUSCITATIONRachel Musoke University of NairobiKNH/UON SYMPOSIUM 10TH Jan 2013
Poor intrapartum fetal oxygenation Also referred as asphyxiaCommon 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)
Contributing factorsThe delaysDelay in recognition of the problem in the motherDelay in transportation to a medical facilityDelay in providing appropriate care at the health facility
Solutions to reduce deaths & disability
Primary prevention maternal care (early recognition & management)Secondary prevention appropriate neonatal resuscitationTertiary prevention recognition & management of acute complications
The Global Need for neonatal Resuscitation, FIGO, Wall et al
The Global Need for neonatal Resuscitation, FIGO, Wall et al
Which babies need resuscitation?Assess: Gestation term or preterm?Breathing or Crying?Good tone?If NO then act quicklyThe first golden minute
The ABC of resuscitationAirway (Position and clear)Breathing (stimulate to breathe)Circulation (Majority of babies have normal hearts)
Warmth
Breathing
Ventilation of babys lungs is the most important and effective action in neonatal resuscitation
Room air vs.O2 for ResuscitationTerm InfantsPre-Term Infants(< 32 weeks)
Room air or oxygen?Term infants: Mortality lower with room air vs 100% O2Shorter recovery
PretermBalance the needs for oxygen vs possible toxicity
Oxygen saturations at birth
1 minute60-65%
2 minutes65-70%
3 minutes70-75%
4 minutes75-80%
5 minutes80-85%
10 minutes85-95%
Meconium stained liquor
Clear mouth & nose before drying & stimulation to avoid aspiration
Suctioning of the trachea reserved for nonvigorous babies
EquipmentsWarmth towels & heaterAirway suction cathetersVentilate bag (500ml). & masks (sizes)Source of oxygen (& blender)Auscultate stethoscopePulse oximeter (if possible)Intubation equipment
Key behavior skillsKnow your environmentAnticipate & planCall for help & work as a teamThe person present must initiate resuscitationCommunicate effectivelyUse all available resources
SUMMARY
Effective ResuscitationAirway & BreathingCirculationDrugs
SummaryEverybody who conducts a delivery must be able to resuscitate
We should be prepared at all times
Lets give our newborn a good start
Comparable to malaria. 78-90% die in 1st 48hrs of delivery. 25-29% of survivors have moderate to severe impairment Double that due to diabetes & almost of burden due to HIV/AIDS. **
There are concerns about potential adverse effect of 100% oxygen on breathing physiology, cerebral circulation, and potential tissue damage from oxygen free radicals.
The new recommendations are divided into two groups by gestational age: Term and Pre-Term (