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Neonatal Resuscitation

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

1 Dr. Muhammad Zahoor ul Haq Assistant Professor of Paediatrics RMC Rawalpindi

2 Neonatal Resuscitation

3 Neonatal Resuscitation
Resuscitation is active intervention to establish normal cardio respiratory function 5-10% require active intervention

4 Goal To prevent morbidity & mortality associated with hypoxic ischemic tissue (brain, heart, kidney) injury Anticipate high risk situations

5 Guideline for neonatal resuscitation
Guideline for neonatal resuscitation Integrated assessment / response approach for initial evaluation of an infant Color - General appearance - Risk factor

6 Fundamental Principles. - Evaluation of airway
Fundamental Principles - Evaluation of airway - Establishing effective respiration - Establishing adequate circulation

7 Immediate Care. - Place under radiant heater. - Dry
Immediate Care - Place under radiant heater - Dry - Position (head down & slightly extended) - Clear airway - Gentle tectile stimulation

8 Assess - Infant’s color - Heart rate

9 Evaluate respirations
Approximate time The Fetus and Neonatal Infant BIRTH Routine care . Provide warmth . Clear airway if needed . Dry . Assess color 30 Seconds Term gestation? Amniotic fluid clear? Breathing or crying? Good muscle tone? Yes Provide warmth Position; clear airway* (as necessary) Dry, stimulate, reposition Breathing HR> & Pnk Observational Care Evaluate respirations Heart rate, and color

10 Give supplementary Oxygen
Breathing HR> & Pnk Evaluate respirations Heart reate, and color Observational Care Breathing HR>100 but Cyanotic Pink Give supplementary Oxygen 30 Seconds Apnea or HR <100 Effective Ventilation HR>100 & pink Persistent Cyanosis B Postresuscitation Care Provide positive –pressure ventilation HR<60 HR>60 C 30 Seconds Provide positive pressure ventilation Administer chest compression HR<60 D Administer epinephrine and or volume*

11 Give supplementary Oxygen
Approximate time The Fetus and Neonatal Infant BIRTH Term gestation? Amniotic fluid clear? Breathing or crying? Good muscle tone? Routine care . Provide warmth . Clear airway if needed . Dry . Assess color Yes No A Provide warmth Position; clear airway* (as necessary) Dry, stimulate, reposition 30 Seconds Breathing HR> & Pink Evaluate respirations Heart rate, and color Observational Care Breathing HR>100 but Cyanotic 30 Seconds Apnea or HR <100 Pink Give supplementary Oxygen Effective Ventilation HR>100 & pink B Persistent Cyanosis Provide positive –pressure ventilation Postresuscitation Care C HR<60 HR>60 30 Seconds Provide positive pressure ventilation Administer chest compression D HR<60 Administer epinephrine and or volume*

12 Respiratory Effort. Steps. Follow ABCs. A-. Anticepate & establish. B-
Respiratory Effort Steps Follow ABCs A- Anticepate & establish B- Initiate Breathing C- Maintain Circulation D- Drugs

13 If no respiration or heart rate below 100/min
If no respiration or heart rate below 100/min - Give positive pressure with face mask Endotracheal intubation

14 If heart does not improve then:. - Start chest compression. - Site
If heart does not improve then: - Start chest compression - Site Lower third of sternum :1

15 If no improvement give epinephrine

16 Poor response to Ventilation. - Loosely fitted mask
Poor response to Ventilation Loosely fitted mask - Poor position of ETT - Intraesophageal intubation - Airway Obstruction - Insufficient pressure - Excess Air in Stomach

17 Administration of Naloxone Hydrochloride. Ind:
Administration of Naloxone Hydrochloride Ind: - Respiratory depression - Mother has H/O narcotic - Drug administration Dose:- 0.1mg/kg ½, intratracheal

18 Emergency Volume Expander. - Isotonic crystalloid solution. 10-20ml/kg
Emergency Volume Expander - Isotonic crystalloid solution ml/kg - O -ve blood

19 Sodium Bicarbonate. - Indication. - Documented metabolic acidosis
Sodium Bicarbonate - Indication Documented metabolic acidosis Prolong resuscitation - Dose - 2meq/kg ½

20 Dopamine or Dobutamine Ind: - Cardiogenic shock - Dose 5-20mg/kg/min

21 Infusion Epinephrine. Ind:. - Unresponsive Cardiac shock. Dose:. - 0
Infusion Epinephrine Ind: - Unresponsive Cardiac shock Dose: mg/kg/min

22 Primary Apnea. →Asphyxia →Reduce
Primary Apnea →Asphyxia →Reduce Heart rate → apnea Immediate Intervention - Oxygen inhalation - Tectile stimulation

23 Secondary Apnea. - Gasping respiration. - Bradycardia. - Hypotension
Secondary Apnea - Gasping respiration - Bradycardia - Hypotension - Finally apnea Immediate Intervention - Positive pressure ventilation

24 Equipment Required. - Resuscitation table. - Sterile Linen
Equipment Required - Resuscitation table - Sterile Linen - Suction apparatus ( Catheter 5, 6, 8) - Laryngoscope with straight blade - Ambo bag with face mask - Endotracheal tube - Gloves

25 Medications. - Epinephrine 1:10,000. - Naloxone hydrochloride
Medications - Epinephrine 1:10, Naloxone hydrochloride - Volume expander - Soda bicarbonate % Dextrose water - Sterile water

26 Miscellaneous. - Radiant warmer. - Stethoscope. - Adhesive tape
Miscellaneous - Radiant warmer - Stethoscope - Adhesive tape - Syringes - Butterfly needle - Umbilical artery - Catheterization tray

27 Indication for Endotracheal tube. Intubation
Indication for Endotracheal tube Intubation - Ineffective bag & mask ventilation - Prolong PPV required - Suspicion of diaphragmatic hernia -Preterm infant -Meconium aspiration

28 Stop Resuscitation If no respiratory & cardiac activity after 20 min of resuscitation Fixed pupil

29 Thank You


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