Download - Newborn Emergencies
EMSResuscitation of
the Newborn
Jim Morgan, D.O. FAAEMEmergency MedicineEMS Medical Director
Joplin, MO
EpidemiologyEpidemiology
10% of newborns will require “assistance” when they’re born
Incidence of complications increase as Birth weight decreases Prenatal problems increase Prenatal age decreases
Look for antepartum & intrapartum issues
PhysiologyPhysiology
Prior to delivery, newborn lungs filled with fluid
Capillaries & arterioles of lungs are closed
Blood pumped by heart bypasses lungs thru ductus arteriosis
Ductus ArteriosisDuctus Arteriosis
PhysiologyPhysiology
During delivery (or shortly after), the newborn begins using lungs Compression of chest removes fluid Sudden inspiration causes air movement
to displace fluid Resistance thru lungs decreases & blood
flow preferentially bypasses ductus
Ductus closes & becomes ligamentum arteriosum
Initial CareInitial Care
Airway Maintain at level of mother’s vagina Bulb suction Gentle stimulation
Assess initial APGAR score
Prevent heat loss Gently dry Swaddle in warm receiving blanket Avoid air drafts Skin-to-skin with mother
Cutting umbilical cord Do not milk the cord Clamp 30 seconds after delivery Clamp ~ 4 cm from newborn
At BirthAt Birth
Is newborn full-term?
Is newborn breathing &/or crying?
Does newborn have good muscle tone?
At BirthAt Birth
Is meconium present? Thin meconium Thick meconium
Assess O2 saturation 60 – 70% at birth May take 5 – 10 minutes to reach > 95%
Cyanosis common esp. acrocyanosis
HR ~ 150 – 180 slowing to 130 – 140 HR < 100 abnormal – begin resuscitation
The Distressed NewbornThe Distressed Newborn
Inverted Pyramid of Inverted Pyramid of
ResuscitationResuscitation
Basic “Resuscitation”Basic “Resuscitation”
Initial care Drying Warming Positioning Suctioning Tactile stimulation
Assessment Respiratory effort Heart rate Color
AirwayAirway
Ventilation HR < 100 Apnea Poor O2 saturation Persistence of central cyanosis
Use neonatal BVM with pop-off valve with supplemental oxygen
Ventilate @ 40 – 60 bpm Ventilate @ ~ 35 – 45 cm H2O OR adequate chest rise
Supplemental oxygen 100% oxygen in the field
Neonatal Ambu BagNeonatal Ambu Bag
AirwayAirway
Consider intubation Chest compressions Difficult to ventilate Thick meconium Inadequate response
Chest CompressionsChest Compressions
Encircle chest with both hands & use thumbs
Compress lower half of sternum @ 100 per minute
Discontinue if HR increases to > 80
Vascular AccessVascular Access
MOST distressed newborns respond to initial care, ventilation, & chest compressions
If vascular access needed, can use umbilical catheter Umbilical cord with 2 arteries & 1 vein Insert catheter into vein & secure
with umbilical tape
MedicationsMedications
Naloxone Do not use in newborn resuscitation
Glucose No specific glucose level at birth can be agreed
upon Prehospital glucose administration difficult
Epinephrine 0.05 - 0.1 mg/kg
(0.3 to 1 mL/kg of a 1:10,000 solution)
Specific Neonatal Specific Neonatal SituationsSituations
Meconium-stained amniotic fluid Apnea Diaphragmatic hernia Bradycardia Prematurity Respiratory distress/cyanosis Hypovolemia Seizures Fever Hypothermia Hypoglycemia Vomiting Diarrhea Common birth injuries
Congenital heart Congenital heart conditionsconditions
Atrial septal defect (ASD) Ventricular septal defect (VSD)
Tetralogy of Fallot Transposition of the great vessels Coarctation of the aorta Pulmonary stenosis Aortic stenosis
Failure to respondFailure to respond
Mechanical blockage Meconium
Impaired lung function Pneumothorax Diaphragmatic hernia Pulmonary atresia
Central cyanosis Congenital heart disease
Apnea Brain injury Neuromuscular disease
Enroute to the callEnroute to the call
Review how you will handle Normal birth & newborn Newborn in distress
Warm patient compartment
Consider possibility of needing back-up personnel
Remember….Remember….
Most newborns will respond to minimal intervention
If meconium is present AND… Child is vigorous, light suctioning Child is flaccid, may need ETT + suction
If HR > 100, supplemental oxygen Between 60 – 100, positive pressure ventilation < 60, chest compressions
Rarely…..epinephrine thru umbilical vein
Reassess every 30 seconds
Questions?Questions?