dr. muhammad zahoor ul haq assistant professor of paediatrics rmc rawalpindi

Dr. Muhammad Zahoor ul Haq Dr. Muhammad Zahoor ul Haq Assistant Professor of PaediatricsAssistant Professor of Paediatrics

RMC RawalpindiRMC Rawalpindi

Neonatal Neonatal ResuscitationResuscitation

Neonatal Resuscitation Neonatal Resuscitation

• Resuscitation is active Resuscitation is active intervention to establish intervention to establish normal cardio respiratory normal cardio respiratory functionfunction

• 5-10%5-10% require active require active interventionintervention

GoalGoal

• To prevent morbidity & mortality To prevent morbidity & mortality associated associated with hypoxic ischemic with hypoxic ischemic tissue tissue

(brain, heart, kidney) injury(brain, heart, kidney) injury

• Anticipate high risk situationsAnticipate high risk situations

Guideline for neonatal Guideline for neonatal resuscitation resuscitation

Integrated assessment / response Integrated assessment / response approach approach for for initial evaluation of an initial evaluation of an infant infant

- Color - Color - General appearance - General appearance - Risk factor- Risk factor

Fundamental PrinciplesFundamental Principles

- Evaluation of airway- Evaluation of airway

- Establishing effective respiration - Establishing effective respiration

- Establishing adequate circulation- Establishing adequate circulation

Immediate Care Immediate Care - Place under radiant heater - Place under radiant heater

- Dry - Dry

- Position (head down & slightly - Position (head down & slightly extended)extended)

- Clear airway - Clear airway

- Gentle tectile stimulation- Gentle tectile stimulation

Assess Assess - - Infant’s color Infant’s color

- Heart rate - Heart rate

BIRTH

Term gestation?Amniotic fluid clear?Breathing or crying?Good muscle tone?

Routine care. Provide warmth . Clear airway if needed. Dry . Assess color

Provide warmth Position; clear airway*(as necessary)Dry, stimulate, reposition

Evaluate respirations

Heart rate, and color Observational Care

Yes

Approximate

time

Breathing

HR>100

& Pnk

30

S

eco

nd

sThe Fetus and Neonatal Infant

Give supplementary

Oxygen

Provide positive –pressure ventilation

Provide positive pressure ventilation

Administer chest compression

Administer epinephrine and or volume*

Postresuscitation Care

Evaluate respirationsHeart reate, and color

Observational Care

Breathing HR>100

& Pnk

Pink

Apnea or HR <100

Breathing HR>100 but Cyanotic

Persistent Cyanosis

Effective Ventilation HR>100 & pink

HR<60

HR>60

HR<60

B

C

D

30

S

eco

nd

s3

0

Seco

nd

s

BIRTH

Term gestation?Amniotic fluid clear?Breathing or crying?Good muscle tone?

Routine care. Provide warmth . Clear airway if needed. Dry . Assess color

Provide warmth Position; clear airway*(as necessary)Dry, stimulate, reposition

Evaluate respirations

Heart rate, and color Observational Care

Yes

Approximate

time

Breathing HR>

& Pink

30

S

eco

nd

s

The Fetus and Neonatal Infant

Give supplementary

Oxygen

Provide positive –pressure ventilation

Provide positive pressure ventilation

Administer chest compression

Administer epinephrine and or volume*

Breathing HR>100 but Cyanotic Pink

Apnea or HR <100

Postresuscitation Care Persistent Cyanosis

Effective Ventilation HR>100 & pink

HR<60 HR>60

HR<60

A

B

C

D

30

S

eco

nd

s3

0

Seco

nd

s

No

Respiratory EffortRespiratory EffortStepsSteps

Follow ABCsFollow ABCsA-A- Anticepate & establish Anticepate & establish B- B- Initiate Breathing Initiate Breathing C-C- Maintain Circulation Maintain Circulation D-D- DrugsDrugs

If no respiration or heart If no respiration or heart rate below 100/minrate below 100/min

- Give positive pressure with face - Give positive pressure with face maskmask

- Endotracheal intubation - Endotracheal intubation

If heart does not improve If heart does not improve then:then:

- Start chest compression - Start chest compression

- Site - Site

Lower third of sternum Lower third of sternum 3:13:1

If no improvement If no improvement

give epinephrine give epinephrine

Poor response to Poor response to Ventilation Ventilation

- Loosely fitted mask - Loosely fitted mask - Poor position of ETT- Poor position of ETT- Intraesophageal intubation - Intraesophageal intubation - Airway Obstruction - Airway Obstruction - Insufficient pressure- Insufficient pressure- Excess Air in Stomach - Excess Air in Stomach

Administration of Naloxone Administration of Naloxone HydrochlorideHydrochloride

Ind:Ind: - - Respiratory depression Respiratory depression - Mother has H/O narcotic - Mother has H/O narcotic - Drug administration - Drug administration

Dose:- Dose:- 0.1mg/kg ½, intratracheal0.1mg/kg ½, intratracheal

Emergency Volume Emergency Volume Expander Expander

- Isotonic crystalloid solution - Isotonic crystalloid solution 10-20ml/kg10-20ml/kg

- O -ve blood - O -ve blood

Sodium Bicarbonate Sodium Bicarbonate - Indication - Indication

- Documented metabolic - Documented metabolic acidosis acidosis

- Prolong resuscitation- Prolong resuscitation

- Dose- Dose - - 2meq/kg ½2meq/kg ½

Dopamine or Dobutamine Dopamine or Dobutamine Ind:Ind:

- Cardiogenic shock - Cardiogenic shock

- Dose 5-20mg/kg/min- Dose 5-20mg/kg/min

Infusion Epinephrine Infusion Epinephrine Ind:Ind:

- Unresponsive Cardiac shock - Unresponsive Cardiac shock

Dose:Dose:- 0.1-1.0mg/kg/min - 0.1-1.0mg/kg/min

Primary Apnea Primary Apnea →Asphyxia →Reduce →Asphyxia →Reduce Heart rate → apnea Heart rate → apnea

Immediate Intervention Immediate Intervention - Oxygen inhalation - Oxygen inhalation - Tectile stimulation- Tectile stimulation

Secondary Apnea Secondary Apnea - Gasping respiration - Gasping respiration - Bradycardia - Bradycardia - Hypotension - Hypotension - Finally apnea- Finally apnea

Immediate Intervention Immediate Intervention - Positive pressure ventilation - Positive pressure ventilation

Equipment RequiredEquipment Required- Resuscitation table - Resuscitation table - Sterile Linen - Sterile Linen - Suction apparatus ( Catheter 5, 6, 8)- Suction apparatus ( Catheter 5, 6, 8)- Laryngoscope with straight blade - Laryngoscope with straight blade - Ambo bag with face mask- Ambo bag with face mask- Endotracheal tube - Endotracheal tube - Gloves - Gloves

Medications Medications - Epinephrine 1:10,000- Epinephrine 1:10,000- Naloxone hydrochloride - Naloxone hydrochloride - Volume expander - Volume expander - Soda bicarbonate - Soda bicarbonate - 10% Dextrose water - 10% Dextrose water - Sterile water - Sterile water

Miscellaneous Miscellaneous - Radiant warmer- Radiant warmer- Stethoscope - Stethoscope - Adhesive tape - Adhesive tape - Syringes - Syringes - Butterfly needle - Butterfly needle - Umbilical artery - Umbilical artery - Catheterization tray- Catheterization tray

Indication for Endotracheal Indication for Endotracheal tube tube

Intubation Intubation - Ineffective bag & mask - Ineffective bag & mask

ventilation ventilation - Prolong PPV required - Prolong PPV required - Suspicion of diaphragmatic - Suspicion of diaphragmatic

hernia hernia -Preterm infant-Preterm infant-Meconium aspiration-Meconium aspiration

Stop ResuscitationStop Resuscitation

If no respiratory & cardiac If no respiratory & cardiac activity after 20 min of activity after 20 min of resuscitationresuscitation

Fixed pupilFixed pupil