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Newborn resuscitation: A 20 minute baptism of fire
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Newborn resuscitationWhy is resuscitation at birth different?
Newborn Babies:• Are wet so they get cold• Have lungs that are unexpanded and full of fluid•Take minutes for oxygen saturation to rise
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Newborn transition
Kamlin. J Ped 2006
1 minute: 63% (53-68)
5 minutes: 90% (79-91)
63 7077
8490
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Newborn transitionVideo
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Newborn resuscitationWhy is resuscitation at birth different?
Newborn Babies:•Have a facility for agonal (spinal) gasping • a “second chance” for ventilation
•Have hearts that have extra energy to keep going•Have a convenient site for central vascular access
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Newborn resuscitationAsphyxia in utero
10 20 30 40
160
120
80
40
Primaryapnoea
Terminalapnoea
Resps
Pa O2
Pa CO2
Heart rate
minutes
© Northern Neonatal Network
BP
00
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Newborn resuscitationWhy is resuscitation at birth different?
Of the 280,078 live born infants in Australia in 2006:• 61% required no intervention• 16% received oxygen therapy• 15% received suctioning• 6% received bag-mask ventilation• 0.7% received intubation and IPPV• 0.2% received ECM
•AIHW (2008)
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Newborn resuscitation Assessment
Airway, Breathing and Circulation
all assessed before and during resuscitation:
Tone, Breathing, Heart Rate and Oxygenation
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Newborn resuscitationBasic approach
• Maintain normothermia
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Newborn resuscitationBasic approach
• Assess: tone, breathing, heart rate, oxygenation
• Maintain normothermia
• Breathing: inflation breaths; consider PEEP; consider O2
• Circulation: - chest compressions (2 thumb technique) - 3:1 ventilation:ECM- adrenaline via umbilical vein
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Appx Ip342/x
Newborn life support algorithm
Courtesy of the New Zealand Resuscitation Council and Australian Resuscitation Council
www.resus.org.au
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Assessment and airway
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Breathing
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Circulation
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Translation of the evidenceSurvey of Australian and New Zealand maternity hospitals without NICU facilities in 2009-10
• 93% of respondents were aware of ARC algorithm • 91% advocated the use of blended oxygen
• 20% of hospitals had capacity to deliver blended oxygen• 19% of hospitals had guidelines • 38% used pulse oximeters at delivery
Bhola J Paed Ch Health 2012
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Newborn resuscitationSummary
• An approach to resuscitation of the newly born infant is addressed in the APLS course but cannot be adequately taught to equip candidates with the skills to translate the concepts into practice
• Emphasis should be on understanding the normal transition from fetus to newborn and a focus on the importance of providing breathing support when necessary, with strong reference to relevant guidelines
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Newborn resuscitation
Q&A