Neonatal resuscitation

Primary cause of death: NNPD 18 % Other causes 09 % Malformation 29 % Perinatal hypoxia 17 % Infection 27 % Prematurity Deaths (n = 1800) Cause

4 million newborn deaths – Why? almost all are due to preventable conditions

Others: Hypothermia, RD, Jn, Pulm. Haemorrhage, Seizure etc. ICMR 2006

Neonatal resuscitation Asphyxia accounts for 20-25% newborn deaths 10% neonates require some assistance at birth 1% neonates need extensive resuscitative measures

ventilate The most important and effective action is to ventilate the baby’s lungs

Neonatal resuscitation A irwayA irway B reathingB reathing C irculationC irculation

Neonatal resuscitation A irwayA irway B reathingB reathing C irculationC irculation

Before birth Gas exchange in placenta Lung receives very little blood Alveoli are fluid filled

Very little flow to lungs

Alveoli are fluid filled Blood vessels are constricted

Before birth Pulm arterioles constrictedUmbilical arteries feeding low pressure placenta circulation Low pressure in systemic circuit Very little pulmonary blood flow High pressure in pulmonary circuit

After birth Fluid in the alveoli is absorbed Alveoli EXPAND GET FILLED WITH AIR (O 2 ) 1.

After birth Umbilical arteries and veins are clamped Sudden increase in systemic blood pressure 2.

Pulmonary vessels dilate, causing increased blood flow to lungs 3.

After birth Pulm arterioles dilate Umbilical arteries and veins are clamped High pressure in systemic circuit Dramatic increase in pulmonary blood flow Low pressure in pulmonary circuit

Ductus arteriosus constricts Increased oxygen in blood Increased pulmonary blood flow 4.

BeforeAfter

What can go wrong Inadequate breathing hence lung fluid not absorbed Meconium may block airway Blood loss may occur Persistence of constricted pulmonary vessels Myocardium may be depressed Organ systems may be affected by hypoxia/ischemia

Consequences of interrupted transition 1.Low muscle tone 2.Resp depression (apnea / gasping) 3.Tachypnea 4.Bradycardia 5.Hypotension 6.Cyanosis

Changes due to oxygen deprivation

Some dictums If a baby does not breathe immediately after being stimulated >>> secondary apnea Assume every apneic baby is in secondary apnea Longer the duration of compromise, longer it takes for recovery

The resuscitation flow diagram *

Evaluation-Decision-Action cycle Evaluation ActionDecision

Evaluation: By 3 signs 1.Respiration Breathing / cryingBreathing / crying ApneaApnea 2.Heart rate <100 or not<100 or not < 60 or not< 60 or not 3.Color Central cyanosisCentral cyanosis Peripheral cyanosis / pinkPeripheral cyanosis / pink

The resuscitation flow diagram * Evaluation Assessment

Apgar score

Apgar score is great, but not for guiding resuscitation For resuscitation, not all items are requiredFor resuscitation, not all items are required Resuscitation initiated before 1 min when Apgar is assignedResuscitation initiated before 1 min when Apgar is assigned Classification differentClassification different

Requirements Personnel –At least one trained person for all deliveries –Two persons, if high risk; or for advanced resuscitation Equipment

Risk factors of asphyxia Only 50% resuscitation needs are identified prior to birth

Premature babies : concerns 1.May be surfactant deficient 2.Immature brain, poor resp drive 3.Weak muscles, not able to breathe 4.More prone to hypothermia 5.More likely to be infected 6.Prone to intraventricular hemorrhage 7.Small blood volume, prone to hypovolemia 8.Immature tissues, prone to oxygen toxicity

* Care after resuscitation

Prevent, prevent, prevent Infection:asepsis HIV:universal precautions