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 (