Newborn Resuscitation: A way to protect newborn from asphyxia Neonatorum

Newborn Resuscitation: A way to protect newborn from asphyxia Neonatorum

 newborn resuscitation for those babies who fail to start breating on their own

Definition:
Failure to establish spontaneous respiration immediately after complete delivery of the baby is called asphyxia neonatorum.

Normal Respiration:

  • Normal newborn takes first respiration: within 6 seconds, majority within first 20 seconds,
  • Rhythmic respiration: by 30 seconds, and majority by 90 seconds after birth
  • Normal Rate is 40-60/ min

Prognosis / Consequence asphyxia neonatorum:

Causes of asphyxia neonatorum:

  • Failure of respiratory center
    • prolonged hypoxia, birth trauma, maternal sedatives within 4 hours before delivery and preterm
  • Failure of pulmonary expansion (atelectasis)
    • low alveolar surfactant and poor respiratory movements of preterm baby
    • Fetal hypoxia causes lung edema
  • Obstructed air passageCirculatory collapse in neonatal shock
    • Inhaled mcous or meconium and choanal atresia
    • blood loss or cardiac abnormality

Signs and syndromes of asphyxia neonatorum:

  • Baby does not cry or cries very weakly
  • Baby does not breathe or breathes with difficulty, moaning or grunting
  • Does not move, extremities limp
  • Skin color is blue or pale
  • Heart rate is slow or absent

APGAR score:

Signs Score 0 Score 1 Score 2
Appearance Blue or pale Body pink, limbs blue Pink all over
Pulse (heart rate) Nil <100/min >100/min
Grimace Nil Feeble cry Cough or sneezing
Activity and tone Limp Flexion of limbs Active movements
Respiration Nil Slow, irregular Good, crying

Normal = 8-10. Mild asphyxia = 6-8. Moderate asphyxia = 4-6. Severe asphyxia = 0-3

Immediate Care of the Newborn at Birth (for both normal or abnormal newborn)

  • Step-1: Dry and stimuate
  • Step-2: Assess breathing and color
  • Step-3: Decide if resuscitation is needed
  • Step-4: Keep warm
  • Step-5: Tie and cut the cord
  • Step-6: Start breastfeeding

ABCDS of resuscitation: if needed
AIRWAY – make sure the airway is open

Position the baby

Suction the mouth and nose ,and if there is meconium, the pharynx (back of throat) also include in suction.

BREATHING- make sure the baby is breathing

Stimulate to initiate breathing

Use mouth to mouth or ambu bag breathing as necessary

Give oxygen, if available

CARDIAC FUNCTION- make sure the heart is beating

Stimulate the baby.

Do chest compressions when necessary.

Dry the mouth

Warm the baby with a blanket, a light, or the mother’s skin.

SHOCK

Make sure the baby is warm and dry.

MANAGEMENT: If resuscitation is needed.
A. Immediate management:

Steps of resuscitation:

  • Dry & Wrap
  • See Respiration/colour
  • Decide for resuscitation
  • Position, mouth to mouth respiration, ambu bag
  • Cardiac massage
  • Intubation
  • Drug

Subsequent management:

  • Fluid and nutrition should be maintained by IV 10% dextrose, NG tube feeding or oral feeding.
  • To control seizure: Inj. Phenobarbitone 20mg/kg IV followed by maintenance dose of 5-6mg/kg per day.
  • To control oedema: Fluid restriction 20-25% Mannitol may be used
  • IV antibiotic.

Resuscitation Procedure
A. Environment

  • Maintenance of temperature
  • radiant heater
  • warm cloths

B. Positioning

  • 1 inch roll of cloth below shoulder
newborn resuscitation correct position of baby
newborn resuscitation  airways should be straight

 

C) Suctioning
Should not be done always . When?

  • Meconium in amniotic fluid
  • Asphyxiated baby, first mouth then nose

D) Tactile Stimulation

  • Drying
  • Flicking of soles
  • Rubbing the back

E) Assessment

  • Color
  • Respiratory effort.
  • Heart rate
  • Movements or Muscular activities

F) Ventilation

Indications:

  • Apnea
  • Heart rate < 100 beats
  • Persistent central cyanosis

Process:

  • Mouth to mouth
  • Mouth to mask
  • Umbu Bag
  • Endotracheal intubation
newborn resuscitation mouth to mought ventilation
newborn resuscitation using ventilation with bag and mask
Keep in mind:

  • Rate of 40-60 breaths/min
  • Tight face mask should be present
  • Initial long inflation pressure-5 in number
  • Equal bilateral breath sound should be found
  • If good ventilation – count the Heart rate
  • If>100 and increase in respiration –stop ventilation

G) Chest compressions

Indications:

  • If heart rate is <60 beats/min or 60-80 beats/min and not rapidly increasing despite adequate ventilation with 100% O2 for 30 seconds.
  • Discontinuation: Heart rate > 80 b/min
newborn resuscitation  cardiac massage
H) Medications: when?

  • Heart rate < 80 b/min despite adequate ventilation with O2 and chest compression for 30 sec.
  • Route:
    • Umbilical vein
    • Endotracheal tube

What are the drugs used?

  • Adrenaline:
    • Dose: 1-3ml/kg of 1:10,000
  • Volume Expanders:
    • Dose:10ml/kg 5% albumin-Saline or Ringers lactate
  • Sodium Bicarbonate:
    • Prolonged arrest/or
    • profound metabolic acidosis-
    • Dose: 2meq/kg of 4.2%
  • Naloxone:
    • Dose: 0.1mg/kg of 1mg/ml

 

newborn resuscitation  steps to be used

Fig:Inverted pyramid showing relative frequencies of Neonatal resuscitative efforts

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

 
Time is life!
Preparation, skill and speed is essential!
 

 

 

Enhanced by Zemanta

Meet hafiz34

Hafizul Islam has written 7 posts in this blog.

I am a doctor!

GD Star Rating
loading...
GD Star Rating
loading...
Newborn Resuscitation: A way to protect newborn from asphyxia Neonatorum, 10.0 out of 10 based on 2 ratings