newborn care and resuscitation june 24, 2014 michael kim, md newborn care and resuscitation 2014...

Newborn care and resuscitation2014 Emergency Care Trauma Symposium

June 24, 2014

Michael Kim, MD

Topics

• Preparation• Initial assessment• Initial intervention and intervention• HR dependent interventions• Timing and use of O2• Use of pulse oximetry• Advanced care

Kattwinkel J et al. Circulation 2010;122:S909-S919Copyright © American Heart Association

Preparation• Gestational age• Multiple?• Pregnancy complications• Provider assignment• Equipments

– Warm towels– Mask, Bag, O2, Suction– Plastic wrap– Oxygen– Proper sized Laryngoscope, blade, ETT, (RT)– EZ IO– Medication– Advanced support

Initial assessment

• Crying • Breathing • Tone

Term, good cry and tone

Stay with mom, keep warm and transport

If not

• Warm, dry, and stimulate• Clear airway with suction bulb/catheter• Monitor and maintain temperature

• If vigorous, support only • If not vigorous, Suction mouth and nose Endotracheal suction

before PPV

Vigorous or not so vigorous?

Assessment of O2 need/administration

• Birth cyanosis: up to 10 min• Excess and/or deficit are harmful• POX: only when sustained resuscitation is anticipated

Assessment of O2 need/administration

• PPV and O2 administration– Goal: achieve target saturation/HR– Start with RA or blended O2– PPV if apnic, gasping or HR<100– increase O2 if HR < 60 after 90 sec of intervention

Definitive airway

• Endotracheal Intubation: – Initial suctioning of depressed meconium stained

baby– BMV is ineffective– Chest compression is needed

• Laryngeal Mask Airway: if mask or ETT unsuccessful

Chest compressions

• Indicated if HR < 60 after 30 sec of ventilation with O2

• 1/3 AP diameter on lower 1/3 of sternum• 2 thumbs encircling the chest• 2 finger method: not ideal• 90 compressions/ min (3:1)

Vascular access

Medications• Epinephrine if

– HR < 60 with adequate ventilation, 100% O2, and Chest compression

– IV: 0.01 -0.03 mg/kg (1:10,000)– ET: 0.05-0.1 mg/kg (1:10,000)

Approach

• Airway• Breathing• Circulation• Dextrose• Environment

Approach

• Airway• Breathing• Circulation• Dextrose (Don’t Ever Forget the Glucose)• Environment

Newborn care algorithm

Initial evaluation Term, cry, breathing, tone (Pox/perfusion not reliable)

Factors Resp effort, HR, tone , time(POx: later)

Initial intervention Warm, dry, sxn, stim

CPAP indication If resp distress with HR>100

PPV indication if gasping, apnic or HR<100

Oxygen indication If HR<60 after PPV x 90sec

Compression indication If HR<60 after PPV with O2 x 30 sec

IV Epi dose 0.01-0.03 mg/kg (1:10,000)

ET Epi dose 0.05-0.1 mg/kg (1:10,000)

Vascular access Umbilical catheter

Summary

• Preparation• Crying, breathing and tone• Warm, dry and stimulate• Pulse Ox reading misleading• ABCDEFG