1. Neonatal resuscitation
Dr. S. Parthasarathy
MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics PhD (physio)
Mahatma Gandhi Medical college and research institute , puducherry India

2. The need
Approximately 10% of newborns require some assistance to begin breathing at birth.
Less than 1% require extensive resuscitative measures
only 60% of asphyxiated newborns can be predicted antepartum.

3. The need is continuous

4. Initial queries ?? Term gestation? Crying or breathing?
Crying or breathing?
Good muscle tone?

5. yes the baby does not need resuscitation
should not be separated from the mother.
The baby should be dried, placed skin-to-skin with the mother, and covered with dry linen to maintain temperature.
Observation of breathing, activity, and color should be ongoing.

6. “no”
1.Initial steps in stabilization (provide warmth, clear airway if necessary, dry, stimulate)
2.Ventilation
3.Chest compressions
4.Administration of epinephrine and/or volume expansion

7. The golden minute
Approximately 60 seconds (“the Golden Minute”) are allotted for completing the initial steps, reevaluating, and beginning ventilation if required.

8. The goals of resuscitation
to assist
with the initiation and maintenance of adequate ventilation and oxygenation,
adequate cardiac output and tissue perfusion,
normal core temperature
serum glucose

9. To achieve goals, be ready
risk factors are identified early,
neonatal problems are anticipated,
equipment is available,
personnel are qualified and available
a care plan is formulated

10. Respiration equipment
Oxygen supply, Assorted masks
Neonatal bag and tubing to connect to an oxygen source
Manometer, Endotracheal tubes (2.5-4)
Tape and scissors
Laryngoscope (0 and 1 sized blades)
Extra bulbs and batteries
CO2 detectors
Stylettes for endotracheal tubes
Laryngeal mask Airway (optional)

11. Suction equipment Bulb syringe Regulated mechanical suction
Suction catheters (6F, 8F, 10F)
Suction tubing
Suction canister
Replogle or Salem pump (10F catheter)
Feeding tube (8F catheter)
Syringes catheter tipped – 20 ml
Meconium aspirator

12. Fluid equipment Intravenous catheters (22 g)
Tape and sterile dressing material
Dextrose 10% in water (D10W)
Isotonic saline solution
T-connectors
Syringes, assorted (1-20 mL)

13. Advanced procedure ready
Umbilical catheters (2.5F, 5F)
Chest tube (10F catheter)
Sterile procedure trays

14. Trained Personnel
One present
Two or more
-- problems
--- twins

15. Temperature control Dry and keep warm Others
prewarming the delivery room to 26°C
13 covering the baby in plastic wrapping
placing the baby on an exothermic mattress
the baby under radiant heat
prewarming the linen
The goal is to achieve normothermia and avoid iatrogenic hyperthermia

16. Temperature range Normal 36.5-37.5o C Continue
Potential cold stress o C concern
Moderate hypothermia o C Danger
Severe hypothermia < 32o C
Outlook grave, skilled care urgently needed

17. Airway
Clear liquor
Meconium stained liquor

18. Clear liquor – suctioning routine ??
be associated with worsening of pulmonary compliance and oxygenation
reduction in cerebral blood flow velocity when performed routinely (ie, in the absence of obvious nasal or oral secretions)
Apnea, bradycardia, hypotension, and laryngospasm
Think about routine suctioning ??

19. Clear liquor – suctioning routine ??
suctioning immediately following birth (including suctioning with a bulb syringe) should be reserved for babies who have obvious obstruction to spontaneous breathing or who require positive-pressure ventilation (PPV)

20. What is routine Drying and suctioning , If no response,
more vigorous stimulation, slapping the soles of the feet or rubbing the back.
The back should be visualized.
If there is no response to stimulation,
it may be assumed the infant is in secondary apnea, and PPV should be initiated.
infant's respiratory rate, heart rate, and color should be evaluated

21. Meconium stained liquor
Historically
Suction before delivery of shoulders –
not proved useful
routine endotracheal intubation and direct suctioning of the trachea ??
No to active crying babies !!

22. Mec. staining
endotracheal suctioning of nonvigorous babies with meconium-stained amniotic fluid
If intubation difficult and causing brady , don’t try – go back to mask ventilation

23. Administration of Oxygen
Oxyhemoglobin saturation may normally remain in the 70% to 80% range for several minutes following birth
clinical assessment of skin color is a very poor indicator of oxyhemoglobin saturation

24. SPO2 monitor
a preductal location (ie, the right upper extremity, usually the wrist or medial surface of the palm).
Term infants keep SaO2 – %
Preterm – 88-92%
8- 10 litres- oxygen Hood
Monitor progress

25. Temperature
unheated non humidified oxygen sources for the bag-valve-mask device
Intubated ventilated patient – humidified warmed ventilator circuits

26. Positive pressure ventilation
If the infant remains apneic or gasping, or
if the heart rate remains <100 per minute after administering the initial steps.
Assisted ventilation rates of 40 to 60 breaths per minute
Heart rate , SPo2, monitor

27. CPAP
CPAP
recommend administration of continuous positive airway pressure (CPAP) to infants who are breathing spontaneously,
but with difficulty, following birth, although its use has been studied only in infants born preterm

28. Laryngeal mask airways and PPV
Laryngeal mask airways that fit over the laryngeal inlet - effective for ventilating newborns
weighing more than 2000 g
delivered ≥34 weeks gestation
meconium-stained fluid,
during chest compressions,
or for administration of emergency intratracheal medications

29. Endotracheal Tube Placement
Initial endotracheal suctioning of nonvigorous meconium-stained newborns
If bag-mask ventilation is ineffective or prolonged
When chest compressions are performed
For special resuscitation circumstances, such as congenital diaphragmatic hernia or extremely low birth weight

30. Effective ventilation
Heart rate
CO2
SPo2

31. Chest Compressions
Chest compressions are indicated for a heart rate that is <60 per minute despite adequate ventilation with supplementary oxygen for 30 seconds
Ventilation priority
the 2 thumb–encircling hands technique
the 2-finger technique,

32. DRUGS
Drugs are rarely indicated in resuscitation of the newly born infant.
Bradycardia in the newborn infant is usually the result of inadequate lung inflation or profound hypoxemia
Atropine ???

33. Drugs
if the heart rate remains <60 per minute despite adequate ventilation (usually with endotracheal intubation) with 100% oxygen and chest compressions, administration of epinephrine or volume expansion, or both, may be indicated.
The recommended IV dose is 0.01 to 0.03 mg/kg per dose

34. Drugs and infusions
Rarely, buffers, a narcotic antagonist, or vasopressors may be useful after resuscitation, but these are not recommended in the delivery room.
An isotonic crystalloid solution – 10 ml /Kg
Intravenous glucose infusion should be considered as soon as practical after resuscitation, with the goal of avoiding hypoglycemia

35. Discontinue resuscitation
In a newly born baby with no detectable heart rate, it is appropriate to consider stopping resuscitation if the heart rate remains undetectable for 10 minutes

36. After reading neonatal resuscitation
What is shocking ??
NO APGAR score at all.

37. The Apgar score
Evaluate the newborn baby on five simple criteria on a scale from zero to two,
then summing up the five values thus obtained.
The resulting Apgar score ranges from 0 to 10.
The five criteria are summarized using words chosen to form a backronym
(Appearance, Pulse, Grimace, Activity, Respiration.)

38. SCORES Appearance - red peri. Blue total blue
Appearance - red peri. Blue total blue
Pulse ? < > 100
Grimace stim.no mild active
Active tone less flexion good resist
Respir Absent weak ,gasps active cry

39. APGAR score Score of 10 ?? >7 ok 4 – 7 -- to act
1 min, 5 , 10, 15 minutes
Score of 3 0r less persistent – neuro damage

40. What we do - follows ??

41. Prewarm clothes

42. Tray, oxygen weighing machine

43. Equipment

44. Bulb syringe

45. Gentle back massage

46. Ryles tube and aspiration

47. Inj. Vit. K , temperature monitoring with hood oxygen

48. Breast feeds

49. Thank you all