1. Newborn resuscitation: A 20 minute baptism of fire

2. Newborn resuscitation Why is resuscitation at birth different? Newborn Babies: Are wet so they get cold Have lungs that are unexpanded and full of fluid Take minutes for oxygen saturation to rise

3. Newborn transition Kamlin. J Ped 2006 1 minute: 63% (53-68) 5 minutes: 90% (79-91) 63 70 77 84 90

4. Newborn transition Video

5. Newborn resuscitation Why is resuscitation at birth different? Newborn Babies: Have a facility for agonal (spinal) gasping a “second chance” for ventilation Have hearts that have extra energy to keep going Have a convenient site for central vascular access

6. Newborn resuscitation Asphyxia in utero

7. Newborn resuscitation Why is resuscitation at birth different? Of the 280,078 live born infants in Australia in 2006: 61% required no intervention 16% received oxygen therapy 15% received suctioning 6% received bag-mask ventilation 0.7% received intubation and IPPV 0.2% received ECM AIHW (2008)

8. Newborn resuscitation Assessment Airway, Breathing and Circulation all assessed before and during resuscitation: Tone, Breathing, Heart Rate and Oxygenation

9. Newborn resuscitation Basic approach Maintain normothermia

10. Newborn resuscitation Basic approach Assess: tone, breathing, heart rate, oxygenation Maintain normothermia Breathing: inflation breaths; consider PEEP; consider O 2 Circulation: - chest compressions (2 thumb technique) - 3:1 ventilation:ECM - adrenaline via umbilical vein

11. Appx I p342/x Newborn life support algorithm Courtesy of the New Zealand Resuscitation Council and Australian Resuscitation Council www.resus.org.au

12. Assessment and airway

13. Breathing

14. Circulation

15. Translation of the evidence Survey of Australian and New Zealand maternity hospitals without NICU facilities in 2009-10 93% of respondents were aware of ARC algorithm 91% advocated the use of blended oxygen 20% of hospitals had capacity to deliver blended oxygen 19% of hospitals had guidelines 38% used pulse oximeters at delivery Bhola J Paed Ch Health 2012

16. Newborn resuscitation Summary An approach to resuscitation of the newly born infant is addressed in the APLS course but cannot be adequately taught to equip candidates with the skills to translate the concepts into practice Emphasis should be on understanding the normal transition from fetus to newborn and a focus on the importance of providing breathing support when necessary, with strong reference to relevant guidelines

17. Newborn resuscitation Q&AQ&A