NEWBORN NEWBORN RESUSCITATIONRESUSCITATION

A.SWAROOPAMSC(NURSING)

PEDIATRIC NURSING

PRIMARY CAUSE OF DEATH

18 %Other causes09 %Malformation29 %Perinatal hypoxia17 %Infection27 %Prematurity

DEATHSCAUSE

4 MILLION NEWBORN DEATHS – WHY?ALMOST ALL ARE DUE TO PREVENTABLE

CONDITIONS

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INTRODUCTIONBasic Life Support needed for patient whose breathing or heart has stoppedVentilations are given to oxygenate blood when breathing is inadequate or has stoppedIf heart has stopped, chest compressions are given to circulate blood to vital organsVentilation combined with chest compressions is called cardiopulmonary resuscitation (CPR)CPR is commonly given to patients in cardiac arrest as a result of heart attack

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Indications for resuscitationAntepartum factorsIntra partum factorsPost partum factorsANTEPARTUM FACTORS:Maternal diabetesMaternal infectionsHydromniasPost term gestationMaternal drug abuseLike respiridine, lithium, carbonate etc.

PRENATAL FACTORS

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INTRANATAL FACTORS:Abnormal presentations.Premature labor.Early rupture of membranes.Foul smelling amniotic fluid.Precipitate labor.Fetal bradycardia.Cord prolapse.Meconeum stained amniotic fluid.Narcotic administration to mother with in 4 hrs of delivery.

PERINATAL FACTORS

ABC’s of ResuscitationA - establish open airway Position, suction

B - initiate breathing by Tactile stimulation, Oxygen

C - maintain circulation Chest compression

D - Medications

A B C (A: Airway, B: Breathing, C: Circulation)

•Initial steps:–Thermal management–Positioning–Suctioning–Tactile stimulation

Sign 0 1 2

Heart rate Absent <100beats/min

>100beats/min

Respirations Absent Weak cry Strong cry

Muscle tone Limp Some flexion Active motionReflex No response Grimace Active

withdrawalColor Blue, pale Body: pink

Extremities:blue

Completelypink

1.Anticipation. 2.Adequate preparation.3. Initial stabilization and evaluation.4.Timely recognition, Quick and correct action

are critical for the success of resuscitation

Resuscitation must be anticipated at every birth. Every birth attendant should be prepared and able to resuscitate

For resuscitation:For resuscitation:1. A self-inflating Ambu bag (newborn

size) 2. Two infant masks (for normal and

small newborn), 3.A suction device (mucus extractor),4.A radiant heater (if available), warm

towels, a blanket and 5.A clock are needed

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This consists of :This consists of :drying, (thermal management) positioning

the neonate under radiant warmer to minimize heat loss, suctioning of mouth

and nose (Tracheal suctioning if meconium present) and provide tactile stimulation.

This should only take approximately 20 seconds

(1)Open the airway(1)Open the airway

Put the baby on its backPosition the head so that it is slightly extended .

The upper airway (the mouth then the nose) should be suctioned to remove fluid if

stained with blood or meconiumblood or meconium

If the chest is rising symmetrically with frequency >30/minute,

no immediate action is needed

(2) If there is no cry, (2) If there is no cry, assess breathing:assess breathing:

If the newborn is not breathing or gasping

Immediately start resuscitation.There are two techniques to provide breathing1.Technique for artificial respiration2.Positive pressure ventilation.

1.Technique for artificial respiration

• CLEAR THE MOUTHOF MUCOUS.• HYPER EXTEND THE NECK WITH

ONE HAND, CLAMP THE NOSTRILS WITH FINGERS OR

• SEAL NOSE AND MOUTH OR NOSE ONLY

• TAKE DEEP BREATH AND FORCE AIR INTO LUNGS.

When no equipment is available:

mouth to mouth-and-nose breathing

should be done.

for ensuring adequate ventilation of the lungs, oxygenation of vital organs, and

initiation of spontaneous breathing.

The most important aspect of The most important aspect of newborn resuscitationnewborn resuscitation

Ventilation can almost always be initiated using a bag and mask.2 basic kinds of resuscitation bags are available.

Self inflating bagFlow inflating bag

(it is rarely necessary to intubate)

OUT LINE PROCEEDURE TO VENTILATE

Select the appropriate mask Reposition the newborn Make sure that the neck is slightly extended. Place the mask on the newborn's face, so that it covers the chin, mouth and nose .

Form a seal between the mask and the infant's face. Squeeze the bag with two

fingers only.There should be noticeable rise and fall

of chest with each inflation .

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EVALUATE THE HEART RATE After 30 sec , count the heart rate for 6sec and multiply it by 10 to obtain heart rate per mt.If the HR is >100bpm and infant has spontaneous respirations discontinue ventilation, provide tactile stimulations and free flow oxygen.If HR is <100 bpm ensure ventilation with 100% oxygen initiate chest compression.

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CHEST COMPRESSION:When ever the HR remains < than 60bpm inspite of positive pressure ventilation.2 types :I.THUMB TECHNIQUEII.TWO FINGER TECHNIQUEoPressure to be applied vertically.oCannot use effectively if the baby is large or if our hands are small.oPosition of the baby on firm surface with neck slightly extended.

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Location:lower third of sternum which lies between the xyphoid and the line drawn between nipples.Depth of compression:Infant: 1/2-3/4 ‘’ Child:1-1 ½”Compression and ventilation rates and ratios:For adult-30 compression and 2 breaths.For infant and child-15:2

CHEST COMPRESSIONS:• Place thumbs of both hands on sternum while fingers

encircle chest• Compress breastbone with both thumbs while fingers

support the back.

Two-Rescuer CPR: Infants

Rescuer 1 checks ABCs. Rescuer 2 locates site for chest compressions.

After effectively ventilating for about 1 minute, stop briefly but do not

remove the mask and bag and look for spontaneous breathing

If there is none or it is weak, continue ventilating until spontaneous

cry/breathing begins.

If breathing is slow (frequency of breathing is <30), or if there

is severe chest indrawing: continue ventilating and ask for

arrangement for referral if possible

A newborn will benefit from transfer only if it is properly ventilated and

kept warm during transport

Stop ventilation

If there is no gasping or breathing at all after 20 minutes of ventilation:

Do not separate the mother and the newborn. Leave the newborn skin-to-skin with the mother

Encourage breast-feeding within one hour of birth. The newborn that needs resuscitation is at higher risk of developing hypoglycemia. Observe suckling .

Good suckling is a sign of good recovery.

1.Stimulate the heart so that it supplies oxygen, nutrition to the body and vital organs.

2.Increase tissue perfusion3.Restore acid-base balance. 4.Correct acidosis.

Drugs are seldom needed to:

They may be required in newborns who do not respond to adequate ventilation with

100% oxygen and chest compressions.

Sodium bicarbonate is not recommended in the

immediate postnatal period if there is no documented

metabolic acidosis.

It should therefore not be given routinely

to newborns who are not breathing

If it is given administer 2meq/kg

Umbilical vein

Slowly not faster than a rate of 1meq/kg/mt.

Epinephrine in a dose of 0.01-0.03 mg/kg should be administered if the heart rate remains <60 bpm after a

minimum of 30 seconds of adequate ventilation and chest compressions.

Routes: umblical vein, endotracheal,intravenous

NS &RL

10ML/KG

UMBLICAL VEIN

TO BE INFUSED OVER 5-10 MTS.

can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available.

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