Está en la página 1de 8

NEWBORN RESUSCITATION INTRODUCTION: Resuscitation of the newborn is a real emergency, requiring participation of everyone in the labor and delivery

room. A weak fetal heart of less than 100 beats/minute or its regularity during the late stage of labor is a sign of progressive asphyxia that will need resuscitative measures.

RESUSCITATION EQUIPMENT For suction: Mucus aspirator, Meconium aspirator, mechanical suction, suction catheter, feeding tube 6F, 20ml syringe. For Bag and Mask Ventilation: Neonatal resuscitation bag, face masks, oxygen with flow meter and tubing. For Endotracheal Intubation: Endotracheal tubes 2.5, 3, 3.5, 4 and 1 D, laryngoscope with straight blades of size 0 and 1 with extra batteries and bulbs for laryngoscope, stylet and scissors. Medications: Epinephrine, normal saline, sodium bicarbonate, nalxone, sterile water. Miscellaneous: Radiant warmer, umbilical catheters, watch with seconds hand, linen and shoulder roll, stethoscope, adhesive tape, syringes 1 to 50ml, gauze, 3-way stopcock, gloves.

ABC of Resuscitation

Over and above the maintenance of temperature, the major steps in neonatal resuscitation follow the time honored ABC (Airway, breathing and circulation) pattern and should be completed as far as possible within 15 seconds of birth. A (Airway): Anticipate and establish an open airway by Positioning of the neonate. Suction of the mouth, nose and at times trachea. Performing endotracheal intubation and aspiration. B (Breathing): Initiate breathing using: Tactile stimulation, such as slapping the foot, rubbing the back. Positive pressure ventilation (PPV) with a bag and mask or through an endotracheal tube. C (Circulation): Maintain the circulation with: Chest compression and Medications, if needed

Maintenance of Temperature This is achieved by: Placing the neonate under a preheated radiator warmer or alternatively overhead 200 Watt bulb/room heater. Drying the neonate as soon as he is placed under the warmer using a pre warmed towel.

Removing the wet towel and replacing it with a dry and re warmed one.

Opening the Airway Positioning: The neonate should be placed on his back or side with the neck slightly extended to straighten the airway and head kept slightly down to prevent aspiration. Suction: If no meconium is present, first the mouth and then the nose should be gently suctioned. If there is meconium stained amniotic fluid, suction should be done when head is delivered but shoulders are yet to be out. This is termed intrapartum suctioning. After the delivery of the infant, residual meconium in the hypo pharynx should be suctioned out under direct vision laryngoscopy. Endotracheal intubation is indicated in all babies who are depressed and Meconium stained. Initiating Breathing Tactile Stimulation: If the depressed baby fails to have respiration despite drying and suctioning, additional tactile stimulation may be provided by slapping or flickering the soles of the feet and rubbing the back firmly once or twice. Positive pressure ventilation (PPV): If the baby is still depressed (apnea, heart rate <100/min, he should be administered free-flow oxygen (bag and

mask ventilation) or through oxygen through Endotracheal tube. The rate should be 40-60/min for 15-30 seconds. Maintaining Circulation Chest compression (external cardiac massage). It consists of rhythmic compressions of sternum that compress the heart against the spine, raise the intrathoracic pressure and circulate blood into the vital organs. Indication: If after 15-30 seconds of PPV with 100% oxygen, heart rate remains <60/min or it is 60-80/min but not increasing. Procedure In the thumb technique thumbs are employed to compress the sternum while the fingers support the back and the hand encircles the torso. In twofinger technique, the finger tips (middle finger with index finger or ring finger) one hand is employed to compress the sternum. The other hand supports the neonates back. The rate of chest compression should be 120/min and depth 12cm. During the procedure fingers and thumb should never be taken off from the chest. Medication: Depressed neonates failing to respond to adequate ventilation with 100% oxygen and chest compression are candidate for receiving medication in the form of epinephrine, volume expanders, sodium bicarbonate, naloxone and

dopamine. There is no place for dexamethasone, atropine, Mannitol, calcium and dextrose in resuscitation. Epinephrine A 1 in 10,000,0.1-0.3ml/kg (IV, IT). The same dose may be repeated 5 times. Volume Expanders: Normal saline, whole blood, 5% albumin or Ringer lactate is indicated in the event of an acute bleeding with signs of hypovolemia. Sodium bicarbonate: 1 to 2 mEq/Kg/minute of 4.2% solution slowly over 2 minute. Dopamine 5 to 20mcg/kg/minute as continuous IV infusion in poor peripheral perfusion and hypotension. Nalxone 0.01mg/kg (IV, SC, IM, Intrathecal) Donts in Neonatal Resuscitation Dont administer heavy sedation to the mother. Dont do heavy and continuous suction. Dont let the neonate develop hypothermia. Dont carry on with tactile stimulation beyond 2 and never beyond 4 flicks. Dont delay endotracheal intubation in an apneic neonate. Dont blow your lungs into neonates mouth. Dont use full palmar grasp for giving bag and mask ventilation. Dont give respiratory stimulants. Dont slap the back Dont squeeze the rib cage.

Dont force thighs on the abdomen. Dont dilate the anal sphincters. Dont suck the nose first and the mouth later. The breathing effort that follows sucking the nose first may allow secretions in the mouth to be suddenly aspirated into the lower airway.

RESUSCITATION OF THE NEWBORN IN THE DELIVERY ROOM Place baby under radiant heater Dry thoroughly Remove wet linen Position neck slightly extended Suction mouth, then nose Suction trachea it meconium stained fluid Provide tactile stimulation RESPIRATION Evaluate the baby

HEART

RATE

Respiration apnoeic or irregular regular Heart rate <100

respiration -

heart rate > 100

Tactile stimulation

observe colour

No response blue (secondary apnoea)

respiration regular

pink or

HR > 100

accrocyanosis

PPV with 100% O2 for 30 blow by O2Seconds (with bag & mask) 100% 5L/min

observe and

monitor

Evaluate the baby

HR < 60

HR 60-100 & increasing

HR >100 Respiration -

regular

Intubate & continue blow by 100% PPV with 100% O2 Chest compressions if HR <80 Start medications

continue PPV and revaluate

continue

every 30 sec

O2 until pink

También podría gustarte