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NEONATAL RESUSCITATION MUST KNOW STUDY NOTES
- Provide warmth
- Position head and neck to open airway
- Clear secretions if necessary
- Dry baby
- Stimulate **Establishing Effective Ventilation of the baby’s lungs is the MOST IMPORTANT and effective action during resuscitation 4 QUESTIONS TO ASK BEFORE EVERY BIRTH
- What is expected gestational age
- Is the amniotic fluid clear
- How many babies are expected
- Are there any additional risk factors RAPID EVALUATION FOR ALL NEWBORNS IS REQUIRED—ASK IF THE BABY IS:
- Term?
- Tone? (Healthy babies should be active and flex extremities)
- Breathing/Crying? (Gasping is a sign of severely impaired gas exchange)
**If the answer is NO to any of these, the newborn should be brought to the radiant warmer for the initial steps of newborn care Fetal lungs do not participate in gas exchange but are expanded—alveoli is filled with fluid, NOT air but are still expanded—pulmonary vessels are tightly constricted Oxygenated fetal blood leaves placenta through umbilical vein—there is 1 vein, 2 arteries in the umbilicus Opening in atrium is a Patent Foramen Ovale-most blood bypasses lungs through the foramen OR flows from pulmonary artery into aorta through ductus arteriosis Right to left shunting is when blood follows a circulation path and bypasses the lungs Oligohydramnios- deficiency of amniotic fluid Polyhydramnios- excessive amniotic fluid
Chorioamnionitis- inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection- Bacteria ascends from the vagina into the uterus usually caused by prolonged labor Newborns usually require resuscitation because of a problem with respiration leading to inadequate gas exchange -Fetal respiration is performed by the placenta -When placental respirations fail, the fetus receives an insufficient supply of O2 to support cellular function and CO2 cannot be removed Babies temp should be maintained between 36.5- 37.5C (97.7-99.5F) during resuscitation Place baby supine with head and neck in the sniffing position (do not hyperextend or flex-chin to chest) Clear secretions if baby is not breathing, gasping or has poor tone or meconium stained fluid
Suction mouth THEN nose *Remember M before N -can use bulb syringe -if using suction, catheter, set to 80-100 mmHg Dry baby if wet-discard wet towels If baby is less than 32 weeks, wrap in polyethylene plastic
If HR cannot be determined, connect ECG and/or Pulse Ox—pulse ox may not function is HR is too low or baby has low perfusion so ECG would be preferred method
After The Initial Steps Listed Above, What To Do If The Baby Is Not Breathing Or HR Is Low:
- Start PPV if baby is not breathing (apnea) OR if the baby has gasping respirations - Start PPV if the baby appears to be breathing, but the HR is below 100bpm - Call for help if alone at the warmers - If the baby has not responded to the initial steps within the first minute of life, it is NOT appropriate to continue to provide only tactile stimulation What Do You Do If The Baby Is Breathing And The Heart Rate Is At Least 100bpm, But The Baby Appears Persistently Cyanotic? Apply a pulse oximeter Indications to apply a pulse oximeter:
- When resuscitation is anticipated
- To confirm your perception of persistent central cyanosis
- When supplemental oxygen is administered
- When positive-pressure ventilation is required Acrocyanosis is normal-blue hands and feet
- 4 minute-75-80% - 5 minute-80-85% - 10 minute-85-95%
**A healthy newborn breathing room air may take more than 10 minutes to achieve oxygen saturation greater than 90% Supplemental O2 is indicated when the oximeter remains below the target range for baby’s age FREE FLOWING oxygen is when the oxygen is held close to the baby’s mouth and nose-CANNOT GIVE IF BABY IS NOT BREATHING!! *For free flowing oxygen delivery, adjust the flow meter to 10L/min ***** Start free flow oxygen supplementation with the blender to set to 30% oxygen. Using the blender, adjust the oxygen concentration as needed to achieve oxygen saturation target. **Goal is to prevent hypoxia without using excess oxygen to cause hyperoxia To prevent heat loss, oxygen given to newborns for a prolonged period should be heated and humidified
Meconium-stained fluid and a NON-VIGOROUS newborn
- If baby is born through meconium stained amniotic fluid, bring baby to the radiant warmer
- Perform initial steps of newborn care
- Use a bulb syringe to clear secretions- M to N
- If baby is not breathing or HR is less than 100bpm after initial steps are completed, proceed with PPV **Do not intubate for tracheal suction-there is insufficient evidence to continue recommending this practice PIP- peak inspiratory pressure- highest pressure administered with each breath PEEP- positive end-expiratory pressure- the gas pressure maintained in the lungs between breaths when the baby is receiving assisted breaths CPAP- continuous positive airway pressure- gas pressure maintained in the lungs between breathes when the baby is breathing spontaneously RATE- number of assisted breaths administered per minute
IT- inspiratory time- time duration (seconds) of the inspiratory phase of each positive pressure breath
air rather than with oxygen, whose inflow time is limited. It is better to allow the bag to refill over 3– seconds by releasing the pressure of your hand gradually over that time period.
Avoid breaking the mask seal when the bag is refilling because it will allow the bag to refill with room air rather than with oxygen. Free flowing ventilation bag- Unlike a self-inflating bag, which looks like a soft filled football when not in use, an empty free flow inflation ventilation bag looks like a deflated balloon. A flow inflation bag requires constant fresh flow of oxygen into the bag: flow- inflation bags won’t refill if the oxygen source is empty or detached. In addition, you must maintain a good seal on the ventilation mask against the face, otherwise the bag deflates and you can’t ventilate. Flow-inflation, or inflow dependent bags, while more challenging to use, are common on anesthesia machines and in other ICU type settings because they allow finer control of tidal volume, and greater ability to assess the ventilation, and provide a higher FiO2. Because the flow-inflating bag is soft, you can easily feel lung compliance and changes in resistance. When ventilating a neonate with a 500 ml bag, extremely fine control of tidal volume is possible, even while giving tidal volumes less than 50 ml. With spontaneous ventilation, you can actually see and feel the bag partially deflate with each inhalation before it reinflates with the gas flow. The amount of deflation
bag that may lure you into a false sense of security because it’s always full, even if the lungs are not filling well. On the negative side, unlike self-filling bags, there must be a good seal of the mask against the face to allow a flow inflation bag to provide positive pressure. A poor seal causes the flow inflation bag to deflate like a big balloon. A novice ventilator may have difficulty maintaining the seal needed. Because flow inflation bags are dependent on an oxygen source and require more training, emergency ventilation is usually provided by self-inflating bags. T-piece resuscitator-
Epinephrine Epinephrine is indicated if the baby’s HR remains below 60 bpm after:
- At least 30 seconds of PPV that inflates the lungs and…
- Another 60 seconds of chest compressions coordinated with PPV using 100% oxygen Epinephrine is NOT indicated before you have established ventilation that effectively inflates the lungs Concentration Epinephrine is available in 2 concentrations ONLY the 1:10,000 preparation (0.1mg/ml) should be used for neonatal resuscitation
