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Newborn care and resuscitation June 24, 2014 Michael Kim, MD Newborn care and resuscitation 2014 Emergency Care Trauma Symposium June 24, 2014 Michael.

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Presentation on theme: "Newborn care and resuscitation June 24, 2014 Michael Kim, MD Newborn care and resuscitation 2014 Emergency Care Trauma Symposium June 24, 2014 Michael."— Presentation transcript:

1 Newborn care and resuscitation June 24, 2014 Michael Kim, MD Newborn care and resuscitation 2014 Emergency Care Trauma Symposium June 24, 2014 Michael Kim, MD

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

3 Kattwinkel J et al. Circulation 2010;122:S909-S919 Copyright © American Heart Association

4 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

5 Initial assessment Crying Breathing Tone

6 Term, good cry and tone Stay with mom, keep warm and transport

7 If not Warm, dry, and stimulate Clear airway with suction bulb/catheter Monitor and maintain temperature

8 If vigorous, support only If not vigorous,  Suction mouth and nose  Endotracheal suction before PPV Vigorous or not so vigorous?

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10 Assessment of O2 need/administration Birth cyanosis: up to 10 min Excess and/or deficit are harmful POX: only when sustained resuscitation is anticipated

11 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

12 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

13 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)

14 Vascular access

15 Medications Epinephrine if – HR < 60 with adequate ventilation, 100% O2, and Chest compression – IV: mg/kg (1:10,000) – ET: mg/kg (1:10,000)

16 Approach Airway Breathing Circulation Dextrose Environment

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

18 Newborn care algorithm Initial evaluationTerm, cry, breathing, tone (Pox/perfusion not reliable) FactorsResp effort, HR, tone, time (POx: later) Initial interventionWarm, dry, sxn, stim CPAP indicationIf resp distress with HR>100 PPV indicationif gasping, apnic or HR<100 Oxygen indicationIf HR<60 after PPV x 90sec Compression indicationIf HR<60 after PPV with O2 x 30 sec IV Epi dose mg/kg (1:10,000) ET Epi dose mg/kg (1:10,000) Vascular accessUmbilical catheter

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


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