1. NEONATAL RESUSCITATION
PRESENTED BY
PHATTRAPONG TANSUPOL MD.

2. หลักการที่จะทำให้การช่วยฟื้นชีวิตประสบความสำเร็จ
1.ความพร้อมของบุคลากร
2.การฝึกฝน
3.การทำงานเป็นทีม
4.ACTION/EVALUATION/DECISION CYCLE
5.อุปกรณ์ที่เพียงพอ และพร้อมใช้งาน

3. ACTION/EVALUATION/DECISION CYCLE
ACTION DECISION

4. ASPHYXIA – THE BASIC
1.Primary Apnea:  When asphyxiated, the infant responds with a increased RR.  If the episode continues, the infant becomes apnic, followed by a drop in HR and a slight increase in BP.The infant will respond to stimulation and therapy with spontaneous respirations.

5. 2. Secondary apnea: after primary apnea,  the infant responds with a period a gasping respirations, falling HR, and falling BP.The infant takes a last breath and then enters the secondary apnea period.The infant will not respond to stimulation and death will occur unless resuscitation begins immediately.
*  Because after delivery of an infant it is impossible to differentiate between primary apnea and secondary apnea, assume the infant is in secondary apnea and begin resuscitation immediately.

6. ASPHYXIA CHANGE

7. APGAR SCORE

8. Anticipation and Recognition of the Neonate in Distress 1
Anticipation and Recognition of the Neonate in Distress 1.Antepartum and intrapartum history
Antepartum Factors
Intrapartum Factors
Age > 35 years Maternal diabetes Pregnancy-induced hypertension Chronic hypertension Other maternal illness (e.g. CVS, thyroid, neuro) Previous Rh sensitization Drug therapy (e.g. magnesium, lithium adrenergic-blockers)
Abnormal presentation Operative delivery Premature labour Premature rupture of membranes Precipitous labour Prolonged labour Indices of fetal distress (FHR abnormalities, biophysical profile)

9. 1.Antepartum and intrapartum history CONT.
Antepartum Factors
Intrapartum Factors
Maternal substance abuse No prenatal care Previous stillbirth Bleeding - 2nd/3rd trimester Hydramnios Oligohydramnios Multiple gestation Post-term gestation Small-for-dates fetus Fetal malformations
Maternal narcotics (within 4 hrs of delivery) General anaesthesia Meconium-stained fluid Prolapsed cord Placental abruption Placenta previa Uterine tetany

10. Equipment
Equipment and medications should be checked as a daily routine and then prior to anticipated need. Used items should be replenished as soon as possible after a resuscitation.
The delivery room should be kept relatively warm and the radiant heater should be preheated when possible. Prewarming of towels and blankets can also be helpful in preventing excessive heat loss from the neonate.

11. Equipment SUCTION EQUIPMENT BAG-MASK EQUIPMENT BULB SYRINGE
SUCTION CATH NO Fr
8 Fr FEEDING TUBE 20 ml SYRINGE
MECONIUM ASPIRATOR
BAG-MASK EQUIPMENT
FACE MASK
ORAL AIRWAY
OXYGEN

12. Equipment CONT. INTUBATION EQUIPMENT LARYNGOSCOPY-BLADE NO 0-1
BATTERY FOR LARYNGOSCOPE
ETT NO mm
STYLET SCISSOR GLOVE
MISCELLANEOUS
RADIANT WARMER-STETHOSCOPE-TAPE-
SYRINGE-NEEDLE-ALCOHOL-UMBILICAL CATH

13. Initial Steps for Neonatal Resuscitation in Delivery Room
ANTICIPATION
ASSESSMENT OF ACTION
1.PREVENT HEAT LOSS
Place the infant under an overhead radiant heater to minimize radiant and convective heat loss.
Dry the body and head to remove amniotic fluid and prevent evaporative heat loss. This will also provide gentle stimulation to initiate or help maintain breathing.

14. Initial Steps for Neonatal Resuscitation in Delivery Room CONT.
2.ABCDE STEP
A-AIRWAY
POSITION
CLEAR AIRWAY-SUCTION MOUTH THEN NOSE

15. Initial Steps for Neonatal Resuscitation in Delivery Room CONT.
B-BREATHING ADEQUACY
1.TACTILE STIMULATION
slapping or flicking the soles of the feet
rubbing the back gently
Do not waste time continuing tactile stimulation if there is no response after seconds.
2.FREE FLOW OXYGEN 3.PPV

16. Initial Steps for Neonatal Resuscitation in Delivery Room CONT.
C-CARDIOVASCULAR RESUSCITATION
D-DRUG
-DIAGNOSIS
E-ENVIRONMENT
-EXTENDED CARE

17. Resuscitation in the delivery room

18. PPV 1.INDICATION FOR PPV 2.BAG-Self inflating vs. flow dependent bag
APNEA OR GASPING
HR < 100 bpm
CENTRAL CYANOSIS
2.BAG-Self inflating vs. flow dependent bag
3. Rate bpm
4. Pressure used =
a.  Initial breath after delivery = cm H2O       b.  Normal delivery = cm H2O        c.  Diseased Lungs =20-40 cm H2O

19. PPV CONT.
5. Technique/Trouble shooting problems of Bag mask ventilation
a. Check for a good seal     b. Check for a patent airway      c. Are you using enough pressure ?
6.Checking for chest movement
check mask position
head position-hyperflexion or hyperextention
secretion obstruction
slighly open infant mount
checking for pressure

20. Chest compression 1. Indications:
If after seconds of positive pressure ventilation with 100% FIO2 the heart rate is
a. below 60 bpm b.between bpm and not increasing
2. Technique: a. 1 fingers breadth below nipple line, using 2 fingers        b. 1/2 to 3/4 compression depth        c. accompanied by ventilations, ratio is 3:1

21. METHOD

22. ENDOTRACHEAL TUBE INTUBATION
1.Indications for intubation:
a.  Prolonged bag and mask ventilation       b.  Bag and mask is ineffective       c. Tracheal suctioning
2.Tube size
Tube size Weight Gestational Age (ID mm) (gm) (weeks)
2.5 <1000 <28
> >38

23. ดูว่าท่อหลอดลมอยู่ในตำแหน่งที่เหมาะสมโดย
1.ฟังปอดได้ยินเสียงเท่ากัน 2 ข้าง
2.ฟังที่กระเพาะอาหารไม่ได้ยินเสียงลม
3.ทรวงอกเคลื่อนไหวเท่ากัน 2 ข้าง

24. MEDITATION 1.Indication
HR < 80 bpm despite 100% O2 and chest compression 30 sec
No heart rate

25. Drug -adrenaline -volume expander -NaHCO3 -Dopamine
-Naloxone hydrochloride

26. Drug dosage Drug Preparation Dosage Rate/Precautions
Epinephrine 1:10,000
1 ml
mg/kg ml/kg
Give rapidly IV or ET Repeat q 3-5 min (ET: dilute to 1-2 ml with NS)
Volume Expanders -NS or RL -5% Albumin -O-neg Blood
40 ml
10 ml/kg
Give IV over 5-10 min
Naloxone
0.4 mg/ml
1.0 mg/ml
0.1mg/kg
0.25ml/kg
0.1 ml/kg
Give rapidly IV or ET preferred

27. Drug dosage cont. Reserved for prolonged resuscitations only
Sodium Bicarbonate (0.5 mEq/ml = 4.2% soln)
20 ml
10 mlx2
2 mEq/kg (4ml/kg)
Give slowly, over at least 2 min, IV ONLY, Infant must be ventilated
Dopamine (6 x weight in kg = mg of dopamine diluted to 100 ml)
100 ml
Continuous infusion by pump

28. ทารกที่ไม่ตอบสนองควรคิดถึง
1.inadequate ventilation: missplaced ETT,inadequate pressure,air leak syndrome
2.Shoke: asphyxia,hypovolumic,septic
3.Congenital anomalies: pulmonary hypoplasia,severe cardiac disease

29. THE END
Thank you