Chapter3 Problems of the neonate and young infant - Neonatal resuscitation - PowerPoint PPT Presentation

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Chapter3 Problems of the neonate and young infant - Neonatal resuscitation

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Chapter3 Problems of the neonate and young infant - Neonatal resuscitation Case study: Chan Baby Chan is born at term. He is blue and has poor muscle tone. – PowerPoint PPT presentation

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Title: Chapter3 Problems of the neonate and young infant - Neonatal resuscitation


1
Chapter3 Problems of the neonate and young infant
- Neonatal resuscitation

2
Case study Chan
  • Baby Chan is born at term. He is blue and has
    poor muscle tone. He doesn't cry.

3
  • Routine care of the newborn at delivery
  • Dry baby with clean cloth and place where the
    baby will be warm
  • Look for
  • Breathing or crying
  • Good muscle tone
  • Colour pink
  • Start the resuscitation now!

NO NO NO
4
Neonatal resuscitation (A)
  • Open airway by positioning the head in the
    neutral position (Ref. p. 47)
  • Clear airway, if necessary
  • Stimulate, reposition
  • Give oxygen, as necessary

Baby Chan is still blue and not breathing.
5
Neonatal resuscitation (B)
  • Use a correctly fitting mask
  • Give the baby 5 slow ventilations with bag (Ref.
    p. 47-49)
  • Observe the baby closely!

6
Neonatal resuscitation (C)
  • Baby Chan starts breathing
  • But if the baby is still not breathing (Ref. p.
    47)
  • Check position and mask fit
  • Check the heart rate
  • Continue to bag at rate
  • of about 40 breaths per minute
  • Use oxygen if available
  • Every 1-2 minutes stop and
  • see if the pulse or breathing has improved.

7
History
Baby Chan was born at term. He came out not
crying, blue and with poor muscle tone. He was
reanimated for 2 minutes. Rupture of membranes
happened at home, contractions were regular. His
mother was in labour for a long period of time,
but progressed to normal delivery in hospital. No
chronic illness and no pre-eclampsia were
diagnosed before. Chan is her first baby.

8
Examination after stabilisation
After 2 minutes resuscitation baby Chan was
breathing normally, muscle tone has increased. He
was crying. Vital signs pulse 140/min, RR
50/min Weight 3,2 kg Chest air entry was good
bilaterally and there were no added sounds, no
chest indrawing was noticed Cardiovascular both
heart sounds were audible and there was no
murmur Abdomen soft, bowel sounds were
active Neurology muscle tone middle, no focal
signs

9
What supportive care and monitoring are required?
10
Monitoring
  • The newborn has to be monitored frequently
  • Pay attention to child's breathing, muscle tone
    and ability to drink

11
Monitoring (continued)
  • In the days after birth the newborn may develop
    following problems (Ref. p. 51-52)
  • Convulsions
  • check glucose
  • treat with phenobarbital
  • Apnoea
  • oxygen by nasal catheter
  • resuscitation with bag and mask
  • Inability to suck
  • feed with milk via a nasogastric tube

Treat only if the problems arise
12
Supportive Care
  • If none of the problems described arise provide
    supportive care as for the normal newborn
  • Give the baby to mother as soon as possible,
    place on chest or abdomen
  • Cover the baby to prevent heat loss
  • Encourage initiation of breastfeeding within the
    first hour
  • Keep umbilical cord clean and dry
  • Give vitamin K (phytomenadione), according to
    national guidelines 1 ampoule IM once
  • Apply antiseptic ointment or antibiotic eye drops
    (e.g. tetracycline) to both eyes once
    (prophylaxis), according to national guidelines
  • (Ref. p. 46, p. 50)

13
Breastfeeding support
  • Early and exclusive breastfeeding is very
    important for all newborns.
  • Breastfeeding support
  • Encouragement
  • Breastfeeding friendly environment
  • Breastfeeding, assessment and counselling
  • (Ref. p. 295)

14
Progress
  • Chan's motor tone has recovered well. After his
    mother was encouraged and counselled in
    breastfeeding, he started to suck. After some
    difficulties at the beginning he was sucking
    well. Before he was discharged home he also
    received oral polio, hepatitis B and BCG
    vaccines.

15
Follow-up
  • Baby Chan should receive regular clinical
    follow-up at first-level facilities to monitor
  • His clinical condition
  • Growth
  • Nutritional intake
  • Immunization status

16
Summary
  • Be prepared for resuscitation at every delivery.
  • Learn all steps of neonatal resuscitation by
    heart and train them whenever it is possible.
  • Prognosis for the baby with perinatal asphyxia
    can be predicted by recovery of motor function
    and sucking ability. The prognosis is good for
    babies who respond quick to resuscitation. It is
    worse, if the baby has not recovered motor
    function and cannot suck spontaneously.
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