ETHICAL ISSUES

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NEWBORN RESUSCITATION

• Belen Amparo E. Velasco, M.D.

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ASSESS AND SUPPORT

• TEMPERATURE (warm and dry)
• ABCs
• AIRWAY (position and suction)
• BREATHING (stimulate to cry)
• CIRCULATION (heart rate and
• color

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INVERTED PYRAMID In NB Resuscitation
Dry, Warm, Position, Suction,
Stimulate Oxygen Establish effective
ventilation Chest Compression Medications
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PREPARATION

• ADVANCED PREPARATION
• IMMEDIATE PREPARATION

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ADVANCED PREPARATION

• OBSTETRICAL TRAY
• NB RESUSCITATION TRAY
• RADIANT WARMER/DROPLIGHT

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NB RESUSCITATION EQUIPMENT

• Bulb syringe
• Endotracheal tube (2.5, 3.0, 3.5) and stylets
• Face masks and ambubag
• Feeding tubes
• Gowns, gloves, goggles
• Heat source
• Laryngoscope handles and blades
• Meconium aspirator
• Medications and fluids
• Sterile UC set
• Suction with manometer/catheters
• Syringes (1, 3, 10 and 20 ml)
• Warmed blankets

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IMMEDIATE PREPARATION

• BASED ON RESUSCITATION
• -ORIENTED HISTORY
• VERIFICATION OF AIRWAY
• PATENCY AND PLACEMENT
• OF VASCULAR CATHETERS

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RESUSCITATION-ORIENTED HISTORY

• MECONIUM STAINING
• PREMATURITY
• TWIN PREGNANCY
• NARCOTICS ADMINISTRATION
• TO MOTHER

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FACTORS ASSOCIATED WITH INCREASED RISK FOR
NEONATAL DEPRESSION

• ANTEPARTUM MATERNAL FACTORS
• INTRAPARTUM MATERNAL OR
• FETAL FACTORS

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ANTEPARTUM MATERNAL FACTORS

• Maternal age gt 35 or lt 18
• Chronic and pregnancy-induced HPN
• Diabetes
• Hemorrhage
• Drug therapy (Mg, lithium, adrenergic-blockers
• Substance abuse
• Previous abortion
• No prenatal care
• Anemia or isoimmunization

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ANTEPARTUM MATERNAL FACTORS

• Maternal illness (CV, thyroid,
• neurologic)
• Multifetal gestation
• Small fetus for maternal dates
• Post-term fetus
• Preterm labor or PROM
• Immature pulmonary studies
• Oligohydramnios
• Diminished fetal activity
• Fetal malformation by UTZ

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INTRAPARTUM MATERNAL OR FETAL FACTORS

• Breech or other abnormal presentation
• Infection
• Prolonged labor
• Prolonged rupture of membranes
• Prolapsed cord
• Maternal sedation
• Operative delivery
• Meconium-stained AF
• Indices of fetal distress

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UNIVERSAL PRECAUTIONS

• GLOVES AND OTHER APPROPRIATE
• PROTECTIVE BARRIERS (gowns and
• goggles)
• SUCTION EQUIPMENT SHOULD
• ALWAYS BE AVAILABLE

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INVERTED PYRAMID In NB Resuscitation
Dry, Warm, Position, Suction,
Stimulate Oxygen Establish effective
ventilation Chest Compression Medications
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INITIAL STEPS OF RESUSCITATION (20 seconds)

• PREVENTION OF HEAT LOSS
• PROPER POSITIONING
• SUCTIONING
• TACTILE STIMULATION

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TEMPERATURE REGULATION

• HEAT LOSS MAY BE PREVENTED BY
• REMOVING WET LINENS
• DRYING THE BABY
• PLACING INFANT UNDER
• PREHEATED LAMP/RADIANT
• WARMER

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TEMPERATURE REGULATION

• ALTERNATIVE METHODS OF WARMING
• WARM BLANKETS/TOWELS
• WARM MATTRESSES

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AIRWAY POSITIONING

• PLACEMENT ON BACK OR SIDE WITH
• NECK IN NEUTRAL POSITION
• SHOULDER ROLL (3/4 OR 1 inch) to
• EXTEND NECK SLIGHLY

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AIRWAY SUCTIONING

• IF MECONIUM-STAINED, TRACHEAL
• SUCTIONING
• BULB SYRINGE SHOULD BE ADEQUATE
• IF NOT MECONIUM-STAINED,
• SUCTION MOUTH FIRST THEN
• NOSTRILS

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AIRWAY SUCTIONING

• MAY USE MECHANICAL SUCTION
• WITH 8F OR 10F SUCTION
• CATHETERS AT NEGATIVE
• PRESSURE NOT TO EXCEED
• -100mmHg FOR NO LONGER
• THAN 3 to 5 seconds PER
• ATTEMPT

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TACTILE STIMULATION

• SLAPPING OR FLICKING THE SOLES
• GENTLE RUBBING OF THE BACK

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ASSESSMENT

• RESPIRATORY EFFORT
• HEART RATE
• COLOR

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INVERTED PYRAMID In NB Resuscitation
Dry, Warm, Position, Suction,
Stimulate Oxygen Establish effective
ventilation Chest Compression Medications
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OXYGEN

• 100 OXYGEN SHOULD BE USED
• PREFERABLY WARMED AND
• HUMIDIFIED
• FREE-FLOW O2 BY O2 HOOD
• OR BY FACE MASK ATTACHED TO
• AMBUBAG OR SIMPLE MASK
• HELD TO FACE WITH 5L/min O2
• FLOW

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INVERTED PYRAMID In NB Resuscitation
Dry, Warm, Position, Suction,
Stimulate Oxygen Establish effective
ventilation Chest Compression Medications
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POSITIVE-PRESSURE VENTILATION

• INDICATIONS
• APNEA OR GASPING RESPIRATION
• HEART RATE LESS THAN 100 bpm
• PERSISTENT CENTRAL
• CYANOSIS 100 OXYGEN

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POSITIVE-PRESSURE VENTILATION

• USUALLY PROVIDED WITH BAG
• AND MASK
• VENTILATORY RATE of 40-60/min

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INVERTED PYRAMID In NB Resuscitation
Dry, Warm, Position, Suction,
Stimulate Oxygen Establish effective
ventilation Chest Compression Medications
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CHEST COMPRESSION
INDICATIONS Persistent bradycardia (60-80/min
not increasing) despite 30 seconds of positive
pressure ventilation

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CHEST COMPRESSION

• CHEST COMPRESSION AT A RATIO with BAGGING OF
  13 (Total of 120 events)
• TWO METHODS
• Thumb method
• Two-finger method

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INVERTED PYRAMID In NB Resuscitation
Dry, Warm, Position, Suction,
Stimulate Oxygen Establish effective
ventilation Chest Compression Medications
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MEDICATIONS
EPINEPHRINE INDICATIONS Heart rate of
zero Persistent bradycardia (lt60/min) despite
30 seconds of positive pressure ventilation
and 30 seconds of chest compression

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MEDICATIONS
VOLUME EXPANDERS INDICATIONS Acute blood
loss Non-improvement despite adequate
resuscitation

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MEDICATIONS
SODIUM BICARBONATE INDICATIONS Documented
metabolic acidosis Cardiac arrest

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MEDICATIONS
NALOXONE INDICATIONS Respiratory
depression with maternal history of narcotic
intake within four hours from the time of
delivery

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