Neonatal Resuscitation

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Neonatal Resuscitation

• Mabel Simms
• November 2006

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Neonatal Resuscitation
Aim To enable you to understand the principles
of neonatal resuscitation Learning Outcomes At
the end of the session, you will appreciate
factors that govern different approaches to adult
neonatal resuscitation
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Neonatal Resuscitation

• Learning Outcomes (cont.)
• understand the theory of asphyxia and the
  principles of neonatal resuscitation
• anticipate prepare for the birth of an
  asphyxiated baby
• practice resuscitation techniques on models

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BIRTH ( PERINATAL) ASPHYXIA

• What is it?
• Inadequate Gas Exchange
• What happens?
• ? O2
• ?carbon dioxide retention
• ? lactic acid production
• ? Respiratory Metabolic Acidosis

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BIRTH ASPHYXIA

• If asphyxia prolonged permanent brain injury or
  death
• Why?
• Cell death

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BIRTH ASPHYXIA

• Why is O2 required?
• Cell metabolism
• Aerobic metabolism is desirable
• Why?
• 20 times more energy made

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BIRTH ASPHYXIA

• Anaerobic Metabolism - less energy
• Also results in
• acidosis
• toxic products (lactic acid)
• cell death

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Neonatal Resuscitation

• Why is resuscitation called for?
• Restore circulation/ respiration or both
• What is the purpose of resuscitation?
• Get O2 to respiratory centre

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Neonatal Resuscitation

• What are the differences between neonates and
  adults regarding approach to resuscitation?
• Healthy heart
• Lungs are fluid filled (100 mls at birth)
• Also, easier to resuscitate - soft rib cage,
  small heart

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Neonatal Resuscitation

• Neonates circulation can continue for 20/60 or
  more, in absence of respiration.
• Why?
• Acclimatized to being relatively hypoxic state
  (50-75 secs. during contractions)
• Glycogen stores

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Neonatal Resuscitation

• Explore these 2 issues
• What is THE main factor that can contribute to
  the neonates condition deteriorating rapidly?
• What can be done to minimize this effect?

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Neonatal Hypoxia- Physiology
Resuscitation Council (UK) The Northern Neonatal
Network
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Neonatal Hypoxia- Physiology

• Acute Onset
• Breathing becomes deeper more rapid
• ?pO2
• Consciousness lost
• Regular breathing ceases
• ? Primary Apnoea

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Neonatal Hypoxia- Physiology (cont.)

• No change in heart rate initially, soon starts to
  fall
• No much change in BP
• WHY?

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Neonatal Hypoxia - Physiology

• If insult continues
• Gasping - 12 per minute
• gasping period is variable Why?
• If gasping does not aerate lungs
• ?
• TERMINAL APNOEA

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Neonatal Hypoxia - Physiology

• Summary
• Hypoxic Insult
• Rapid breathing, ?pO2
• Primary Apnoea
• Gasping, ?HR, ?BP, ?Lactic acid
• Terminal Apnoea
• Whole process- about 20/60

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Neonatal Hypoxia - Physiology

• Baby in Primary Apnoea
• - able to resuscitate itself
• - baby will respond to correcting airway
  stimulation
• May require oxygen therapy

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Neonatal Hypoxia - Physiology

• Baby in Secondary Apnoea
• - will die without intervention.
• May die despite intervention!
• Effective lung inflation may be sufficient to
  produce rapid recovery if sufficient circulation
  exists

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Neonatal Hypoxia - Physiology
Resuscitation Council (UK) The Northern Neonatal
Network
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Neonatal Hypoxia - Physiology

• If circulation no longer functional.
• Unable to deliver oxygenated blood from lungs to
  heart despite adequate lung inflation!
• These babies require chest compressions
• IPPV until normal breathing is established

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Neonatal Hypoxia - Physiology
Resuscitation Council (UK) The Northern Neonatal
Network
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Neonatal Resuscitation

• Aim?
• To deliver healthy, breathing, pink babies
• OR when not possible..
• to transfer seriously asphyxiated babies to NNU
  in as good condition as possible!

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Neonatal Resuscitation
At birth assessment of baby includes

• Colour
• Tone
• Breathing
• Heart rate
• Clock, heater, help

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Aim of Neonatal Resuscitation

• Minimise heat loss !!!
• Maintain a clear airway (A)
• Support breathing (B)
• Support circulation (C)
• ?Drugs (D)

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Neonatal Resuscitation

• How do you minimise heat loss?
• Environmental temperature
• Dry baby in warm, dry towel
• Remove wet towel
• Wrap in warm dry towel (skin to skin)

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Neonatal Resuscitation

• Airway Management
• (1) Neutral Position / Jaw Thrust /Guedal airway
• (2) Inflation breaths (x 5 2-3 secs) - Why?
• (3) Ventillation breaths (30/min)

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Neonatal Resuscitation

• How do you determine breathing is present/absent?
• What steps should be taken?
• What would you do to inflate the lungs?
• Dont forget to Ask for HELP!!

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Aim of Neonatal Resuscitation

• Maintain a clear airway (A)
• Support breathing (B)
• Support circulation (C)
• ?Drugs (D)

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Neonatal Resuscitation

• Drugs
• Sodium bicarbonate 4.2 (2- 4 ml/kg) S
• Adrenaline 110,000 (0.1ml/kg) A
• Dextrose 10 (2.5ml/kg) D
• Naloxone 400 ?g/ml
• - not a resuscitation drug!

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Neonatal Resuscitation

• How do you assess circulation status?
• What would you do if
• Heart rate is over 100?
• Heart rate is below 60?

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Neonatal Resuscitation

• Indications for cardiac compressions
• HR below 60 bpm
• HR between 60-80 bpm and not increasing
• Ensure adequate ventilation prior to CC

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Cardiac Compression

• Technique
• 1 finger breadth below nipple line
• - 2 fingers on sternum
• 2-3cm compression depth
• Ventilation ratio is 31 or 90 compressions to 30
  ventilations in 1 minute

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Meconium Present at birth

• If baby is active
• Dry give to mum

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Meconium present at birth

• If quiet
• Dry wrap
• Visualise cord using laryngoscope
• If meconium is present in airways
• - suction under direct vision
• - use wide bore sucker
• Follow Steps A B C ? D

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Neonatal Resuscitation
Summary

• Dry cover baby
• Assess situation
• Airway (position)
• Breathing
• Chest compressions
• (Drugs)

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Neonatal Resuscitation

• Conclusion
• anticipation
• optimal thermal environment
• resuscitation equipment
• staff training

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Neonatal Resuscitation

• Also ensure
• Post resuscitation monitoring
• Communication with parents
• Documentation

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Thankfully, most babies respond well merely to
simple stimulation ie. drying
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References

• Drew D et al (2001) Resuscitation of the newborn
  A practical approach Oxford, Books for Midwives
• Resuscitation Council (UK) 1998 The 1998
  Resuscitation Guidelines for use in the UK
  London,Resuscitation Council (UK)