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