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Neonatal Resuscitation

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Presentation on theme: "Neonatal Resuscitation"— Presentation transcript:

1 Neonatal Resuscitation
Joseph Gilhooly, MD Doernbecher Children’s Hospital

2 NRP 2001

3 Resuscitation Algorithm: 2001

4 Why we need to resuscitate:
pH 7.30 pH 7.00 pH 6.80

5 How often do we use our resuscitation skills?

6 Suction Equipment Warmer & Blankets Bag, Mask, & Oxygen Laryngoscope and ETT Tube

7 Universal Precautions

8 Assessment: Then Appearance Pulse Grimace Activity Respirations

9 Assessment: Now Clear of Meconium? Breathing or Crying? Breathing
Physiologic Parameters (Apgar’s best) Questions to ask yourself Clear of Meconium? Breathing or Crying? Good Muscle tone? Color Pink? Term Gestation? Breathing Heart Rate Color

10 Initial Management: For all deliveries
Provide warmth Position and Clear Airway Dry Give Oxygen (as necessary)

11 Providing Warmth: The cycle of hypothermia
Acidosis Pulmonary Vasoconstriction Anaerobic metabolism Pulmonary Hypertension Tissue hypoxia Right to left shunting Hypoxemia

12 Positioning: Sniffing

13 The “Trusty” Bulb Syringe

14 Clear of Meconium?

15 Color pink?

16 Pulse Oximetry: Resuscitation monitor
Not affected by acrocyanosis Be patient and get a reading If baby in shock, get central IV access

17 Breathing or Crying? Indications for PPV Apnea or gasping
Heart rate <100 even if breathing Persistent central cyanosis (saturation <90%) despite 100% free-flow oxygen

18 Self-Inflating Bag Pressure manometer attaches O2 Reservoir
PEEP valve port ml Bag size

19 Neopuff CPAP Pressure limited ventilation with PEEP Blended oxygen
Eliminates variability associated with bag ventilation

20 Masks Smallest sizes are for preterm infants

21 Make sure the airway is clear
Lift the baby’s jaw into the mask Keep the mouth slightly open Rate 40-60

22 Indications for Intubation
Meconium and baby is not vigorous PPV by bag-mask does not result in good chest rise PPV needed beyond a few minutes Chest compressions necessary Route to administer epinephrine Special indications: Prematurity, CDH

23 Miller 0 Miller 1

24 >2000 gm 3.5 3.0 gm 2.5 <1000 gm Stylet

25 Intubation Technique

26 Lip reference mark: (6 + weight in kilos) cm
9-10 cm at the lip for this term infant

27 Indications for Compressions
Heart rate <60 bpm after 30sec of PPV Coordinate with ventilation 4 events in 2 seconds 90 compressions and 30 breaths per minute One and Two and Three and Breathe 2 seconds

28 2 thumb technique preferred
Compressions 2 thumb technique preferred

29 Medications: Epinephrine
Indication: Heart rate <60 after 30 sec of coordinated ventilation and compressions 1:10,000 (0.1mg/ml) Route: ETT or IV ml/kg 1ml Term 0.5ml Preterm 0.25ml Extreme preterm

30 Extended Algorithm Endotracheal Intubation if not already accomplished
Establish IV access with UVC Stat CXR Discontinue efforts if no heart rate after 15 minutes

31 IV Access: “Low” UVC

32 Volume Indication: No response to resuscitation and evidence of blood loss Normal Saline Ringers or Blood as alternatives 10 ml/kg, may repeat Route: IV (Umbilical vein)

33 Sodium Bicarbonate Indication: Documented or assumed metabolic acidosis Concentration: 4.2% NaHCO3 (0.5meq/ml) Dose: 2meq/kg Route: IV (Umbilical vein)

34 Naloxone (Narcan) Indication: Severe respiratory depression after PPV has restored a normal HR and color and… History of maternal narcotic administration within the past 4 hours Dose: 0.1mg/kg of 1mg/ml solution Route: ETT, IV, IM, SQ

35 Hypoglycemia Blood Glucose <45-60 5cc/k D10W Route IV

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