1. Neonatal Resuscitation

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    dr. Christofel P, Sp.OG (K) FM

     Departemen Ilmu Kebidanan dan Kandungan

    RSUD Kota BekasiDewi Rezeki Arbi

    030.11.074

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    Introduction

    Under normal circumstances, the transitionfrom womb to world is a series of dramatic andrapid physiologic changes leading to the birth of aninfant prepared to continue the processes of

    growth and development. The goal of delivering ahealthy infant intact ready to continue normaldevelopment is, unfortunately, not alwayspossible.

    At birth, neonatal resuscitation may be

    necessary. However, because it is not possible topredict every infant who may require resuscitation,the ability to conduct an eective resuscitation isan integral part of the considerations and planningfor any delivery. Regardless of level of care, a

    trained and eperienced team, readily available, is

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    Elements of Birth

    epression !auses of birth depression

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    Responses to hypoia

    "n the normal fetal circulation,blood returning to the heartfrom the body and placenta isprimarily shunted through theforamen ovale to the left side ofthe heart facilitatingoygenated blood to going tothe head and the heart. #loodthat reaches the right ventricleis shunted through the ductusarteriosus to the aorta,bypassing the lungs as a resultof a high pulmonary vascularresistance. This serves the

    fetus well as the ma$or organ ofgas echange is the placenta

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    Responses to hypoia

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    Responses to hypoia

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    Responses to hypoia

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    *lements of #irth

    epression  +rimary and secondary apneauperimposed on thesecirculatory and hemodynamicchanges is a characteristic

    respiratory pattern response toasphyia. The fetus or neonatewill initiate gasping respirations%which may occur in utero) and,should the asphyia persist, enter

    an apneic phase -nown asprim!r" !pne!."f the asphyia continues, theprimary apnea will be followed bya period of irregular gasping

    respirations. !ontinued asphyiawill lead to a period of unremit

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    *lements of #irth

    epression  +rimary and secondary apnea

    "f an infant is in primary apnea andeposed to oygen when gaspingrespirations ensue, eposure tooygen may be suf0cient to reversethe process. However, once theinfant reaches secondary apnea,positive pressure ventilation is

    required to initiate spontaneousventilation.&urthermore, the longer the durationof secondary apnea, the longer it willta-e for spontaneous respiratory

    eort to return following theadministration of positive pressure

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    *lements of #irth

    epression 

    Use of the Apgar core

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     #esuscit!tion

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    "mportance of establishingventilation

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    *lements of a#esuscit!tion  +reparation for a Resuscitation

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    *lements of a#esuscit!tion  "nitial steps

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     The infant should be throughly dried with allwet blan-ets removed to reduced evaporativeheat loss.

    "mmediately after birth, the infant with anydegree of compromise, or for whom there isany concern, should be placed in themicroenvironment of a preheated radiant

    warmer.

     These simple measures can minimi2e thesigni0cant drop in infant core body temperatureeperienced immediately after birth

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     There are three things that can bedone to help diminish heat loss inthe preterm3small infant. The 0rsttwo should be done before theanticipated delivery4 %i) increase thetemperature of the delivery room

    and %ii) ma-e sure that the radiantwarmer is pre heated before thebirth of the infant.

     The premature and3or small infantrepresents an especially dif0cultproblem from the aspect oftemperature control.

    for infants less than 5' wee-s, it is now recommended that consideration begiven to placing the infant in a standard, food quality ( gallon

    polyethylene bag that can easily be obtained from a grocery store. A hole iscut in the closed end of the bag and the bag slipped over the baby with his or

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     The airway is normally clearedwith the use of a bulb syringe orsuction catheter. The mouth is

    suctioned 0rst and then the nose.

     This is done to 0rst clearsecretions in the mouth andpotentially prevent theiraspiration should deep breaths

    occur with nasal suctioning.8entle suctioning of the mouthwill avoid the re9e bradycardiaassociated with stimulation of theposterior pharyn.

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    "f there is no immediate response to these supplemental methods,positive pressure ventilation should be promptly initiated. !ontinuedtactile stimulation in an unresponsive infant will not succeed and mayprolong the asphyial process. "f, after suctioning and tactilestimulation an infant ehibits apnea or a heart rate of : (;;beats3min, positive pressure ventilation should be initiated.

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    "n the infant who is $re!thin% spont!neousl" withno or minim!l si%ni&c!nt si%ns of respir!tor"distress and whose he!rt r!te is !$o'e , yetwho remains cyanotic, there is general agreementthat there is a need for supplement!l o*"%en.

    However, when to introduce the oygen and at whatlevels to start are not well agreed upon.

    In the $re!thin% inf!nt with a he!rt r!te of!$o'e who !ppe!rs c"!notic, the use of apulse o*imeter may be of some value.

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    Assisted

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    Assisted

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    !hest compressions

    +he meric!n -e!rtssoci!tionmeric!nc!dem" of Pedi!trics currently recommends$e%innin% chest

    compression for a he!rt r!teof less th!n / $e!tsmin. This can be done with the t0o&n%er method, or the thum$method may be used toadminister adequate chest

    compressions.

    "t is currently recommended that chest compressions occur >; times a

    minute with ventilation interposed after every third compression. Thus, in a5 second period, / compressions and ( breath are given. This provides >;compressions and /; respirations in each minute. "ntermittently, chestcompressions should be stopped to chec- for a spontaneous heart rate. "fthe spontaneous heart rate is greater than ?; beats3min compressions maybe stopped.

    "f well coordinated chest compressions and ventilation do not raise the@

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    edications

    "f the heart rate remains below ?;3min, despite ventilation andchest compression, the 0 rst action should be to ensure thatventilations and compressions are well coordinated and optimaland (;;B oygen is being used before proceeding with

    medications.

    S i f C it l

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    Screenin% for Con%enit!lnom!lies

    l h i l

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    E*tern!l physicaleamination

    A rapid eternal physical eamination willidentify obvious abnormalities such as4

    Abnormal facies, and limb, Abdominal wall or spinal column defects.

    A scaphoid abdomen may be a clue to the

    presence of a diaphragmatic hernia, whereas

    a two vessel umbilical cord should alert theeaminer to the increased prob ability ofother congenital abnormalities.

    I l h i l

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    Intern!l physicaleamination

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