Neonatal Resuscitation Guidelines

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Neonatal Resuscitation Guidelines
??. ???????? ??????????
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4 ??????????????????????????????

1. ???????????????????????????? (initial step)
2. ???????????? ( ventilation)
3. ??????????? (chest compression)
4. ????????????????? ( adrenaline and/or volume)

3
??????????????????????????????

• If the answer of these 3 rapid assessment is
  Yes
• term gestation ?
• crying or breathing ?
• good muscle tone ?

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• ?????????????????????????????? (Basic step)
  ??????????
• ????????????????? (provide warm)
• ???????????????? (positioning)
• ??????????????? (clearing airway, suction)
• ?????????????? (dry stimulation)

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• ??????????????????????????????????????????????????
  ???????
• ???? (Warmth)
• ??????????????????
• ?????????????????????????????? (radiant warmer)
• ??????????????????????????????????

6

• ??????????????????????
  (Positioning)
• ????????????????????
• ??????????????????????????????????????????????????
  ?????????????
• ??????????????????????????????????????????????????
  ?????? 2 - 3 ????????? (sniffing position)

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Sniff position
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• ???????????
  (Suctioning)
• ???????????????????????????????
  ???????????????????????? (mouth then nose)
• ??????????????????????????????

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• ?????????????? (dry and
  stimulation)
• ?????????????????????????????
• ???????????????????????????

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????????????????????????? (positive pressure
ventilation, PPV)

• ?????????
• ???????????? ???????????????? ??????????
• ????????????????? 100 ?????/????????????????
  ??????????
• ????????????? 30 ??????

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positive pressure ventilation, PPV

• Self- inflating bag with oxygen reservoir
  200-750 ml
• Face mask

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positive pressure ventilation, PPV

• Technique and method
• First several breaths gt30 cmH2O
• Then normal lung 15-20 bcmH2O
• abnormal 20-40 cmH2O
• Rate 40-60/min
• Oxygen flow 5-10 LPM

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positive pressure ventilation, PPV

• Signs of adequate
• bilateral expansion of lungs
• improve in HR and color
• reevaluate after 30 second
• respiration, HR, oxygen saturation

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• Term ???????? resuscitate ???? room air
• Preterm ????????? blend of oxygen
• ???????? blender
• ???????????? O2 mask without reservoir bag
• ????????? bradycardia (HRlt60) ??????? resuscitate
  ???? oxygen ?????? 90 ?????? ????????????
  100oxygen ?? normal HR

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?????????????????? (endotracheal intubation)

• ??????????????
• PPV ?????????????????
• ????????????
• ???????????
• ????????? ???? ?????????????????, preterm BW
  lt1000 gm

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Endotracheal tube placement
GA (wk) BW (gm) Blade No. ETT size (mm) ETT depth (cm) Suction cath No.
lt28 lt 1000 0 2.5 6 BW (kg) ???? 3 ??????????? ETT 5 or 6F
28-34 1000-2000 0 3.0 6 BW (kg) ???? 3 ??????????? ETT 6 or 8F
34-38 2000-3000 0 3.5 6 BW (kg) ???? 3 ??????????? ETT 8F
gt38 gt 3000 1 3.5-4.0 6 BW (kg) ???? 3 ??????????? ETT 8 or 10F
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Chest compression

• ?????????
• HR lt 60 bpm despite adequate ventilation for 30
  second

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Chest compression

• Two thumb- encircling hands technique
• ??????????????????????????????????????????????????
  ?????????????????????????????????
• ??????????????? 1/3 ??????? sternum ???????????
  1/3 ??? AP diameter
• Ratio 31 of compression to ventilation
• 90 30 --------gt
  120 /min

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Chest compression
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Two finger technique
21
??????????? ??????????????????????????????????

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After 60 second

• Reevaluate
• If HR lt 60 -----gt administer medication
• If HRgt 60 but lt 100 -----gt
• stop chest compression
• continue PPV

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Medication

• Epinephrine
• 0.1 - 0.3 ml / kg IV of 110000
• 0.5 - 1.5 ml / kg ETT of 110000
• Repeat every 3-5 min
• ??????????? ????? 0.1 ml NSS 0.9 ml ????
  insulin syringe

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Medication

• Naloxone (narcan)
• 0.1 mg / kg IV or IM (0.4 mg / ml)
  give rapidly
• Establish adequate ventilation first
• Volume expansion
• NSS 10-20 ml / kg IV in 5-10 min
  indicated for shock

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Withholding resuscitation

• ?????????????????????????????????????
  ?????????????????????????????????????????????
• ????????????????????????????????????????????????

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Withholding resuscitation

• Gestation, birth weight, congenital anomalies
• GA lt 23 wk, BW lt 400 gm, anencephaly, trisomy
  13
• ----gt no CPR
• ????????????????????????????????????? ----gt CPR
  ??????????????? GA 25 wk ???????? congenital
  malformations

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Discontinuing resuscitative effort

• Without signs of life ( heart beat respi.
  effort )
• after 10 min of CPR

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Normal blood pressure in term infant
Age Systolic (mmHg) Diastolic (mmHg) Mean (mmHg)
1 hour 70 44 53
12 hour 66 41 50
Day 1 (Asleep) 70/-9 42/-12 55/-11
Day 3 (Asleep) 75/-11 48/-10 59/-9
Day 6 (Asleep) 76/-10 46/-12 58/-12
Week 2 78/-10 50/-9
Week 3 79/-8 49/-8
Week 4 85/-10 46/-9
MAP PP/3 Pd
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Normal blood pressure in preterm infant
Gestation (wk) Systolic (mmHg) Diastolic (mmHg)
lt24 48-63 24-39
24-28 48-58 22-36
29-32 47-59 24-34
gt32 48-60 24-34
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Key change in Pediatric Basic Life Support

• 1. ???????????????????????? chest compression
  ??????????
• 30 ?? ??????? look listen feel
  ???????????????? 2 ?????
• (C-A-B ?????? A-B-C)
• 2. ????????? high quality CPR
• 3. ????? pulse check ????????????? 10 ??????
  ???????????????
• ????? CPR ???

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• 4. ?????? manual defibrillator ?? infant
  ???????? AED ?????????????

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High-quality CPR ??????????

1. ????????? chest compression ????? ??????? 100/
   ???? ?????? two thumbs ?????????????? ???????????
   coronary perfusion pressure ?????????
2. ?????????????? chest compression ??? 1 ?? 3
   ??????????????????????? 4 ??.?? infant ???? 5
   ??.??????????? (???????????)
3. ???? chest compression ??????????

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• 4. ????? fully recoil
• 5. ??????????????????? single rescue 302, two
  rescue 152 (?????? newborn)

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Key change in Pediatric Advance Life Support

• ???????????????????????????? PALS ????????? CHD
  ??????????? single ventricle physiology ??? PAH
• ???? monitor end tidal CO2
• ????? defibrillation ???????????? 1 ?????
  ????????
• 1 joules/kg ???????? ??? 4 joules/kg
  ????????????
• 4. ??????????? O2 ??????????????????? return
  of spontaneous circulation (ROSC)

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• ??????????????????????????????????????????????????
  ??????????? calcium
• Therapeutic hypothermia (32-34 C ??? 12-24 hr)
  ?????? adolescent ???????????? coma ???
  out-of-hospital VF cardiac arrest

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• ????? !! ??????? bag ??? hyperventilation
• ???????? chest compression ?????????? bag
• 8-10 /min
• ??????????? chest compression ?????? bag
• 12-20 /min

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??????????? endotracheal tube

• Lidocaine
• Epinephrine
• Atropine
• Naloxone
• Flush with 5 ml normal saline followed by
• 5 assisted ventilations

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???????? hypotension ????? systolic
blood pressure

• lt 60 mmHg in term neonate ( 0-28 days )
• lt 70 mmHg in infant ( 1-12 months )
• lt 70 mmHg ( 2 x age in years ) in 1-10 years
• 90 mmHg in children gt 10 years of age

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Endotracheal tube size

• ???? ???? / 4 4 ( ????????? gt 2
  ?? )
• ??????? 3 ??????????? ( cm )

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• Epinephrine
• 110,000 0.1 ml/kg iv/io 11,000 0.1
  ml/kg ET
• Atropine
• 0.02 mg/kg iv 0.04 mg/kg ET
• Naloxone
• 20 kg ---gt 0.1 mg/kg iv/ET
• gt 20 kg ---gt 2 mg iv/ET
• NaHCO3 1 mEq/kg ( 1 ml/kg )

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Defibrillator

• Paddle size
• infant paddle for weight lt 10 kg
• Paddle position
• right side of sternum and
• left side of left nipple ( apex of heart
  )
• Energy dose
• SVT start 0.5-1 J/kg ------gt 2 J/kg
• VF/VT start 2 J/kg ------gt 4 J/kg

THE END