Neonatal Resuscitation
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Transcript of Neonatal Resuscitation
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Neonatal Resuscitation
Joseph Gilhooly, MD
Doernbecher Children’s Hospital
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NRP 2001
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Resuscitation Algorithm: 2001
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Why we need to resuscitate:
pH 7.30 pH 7.00 pH 6.80
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How often do we use our resuscitation skills?
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Bag, Mask, & Oxygen
Suction Equipment
Laryngoscope and ETT Tube
Warmer & Blankets
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Universal Precautions
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Assessment: Then
• Appearance
• Pulse
• Grimace
• Activity
• Respirations
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Assessment: Now
• Breathing
• Heart Rate
• Color
• Clear of Meconium?
• Breathing or Crying?
• Good Muscle tone?
• Color Pink?
• Term Gestation?
Physiologic Parameters (Apgar’s best)
Questions to ask yourself
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Initial Management: For all deliveries
• Provide warmth
• Position and Clear Airway
• Dry
• Give Oxygen (as necessary)
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Providing Warmth: The cycle of hypothermia
Anaerobic metabolism
Acidosis
Tissue hypoxia
Hypoxemia
Pulmonary Vasoconstriction
Pulmonary Hypertension
Right to left shunting
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Positioning: Sniffing
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The “Trusty” Bulb Syringe
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Clear of Meconium?
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Color pink?
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Pulse Oximetry: Resuscitation monitor
• Not affected by acrocyanosis
• Be patient and get a reading
• If baby in shock, get central IV access
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Breathing or Crying?
• Indications for PPV – Apnea or gasping
– Heart rate <100 even if breathing
– Persistent central cyanosis (saturation <90%) despite 100% free-flow oxygen
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Self-Inflating Bag
O2 Reservoir
Pressure manometerattaches
PEEP valve port
200-750ml Bag size
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Neopuff
• CPAP• Pressure limited
ventilation with PEEP• Blended oxygen• Eliminates variability
associated with bag ventilation
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Smallest sizes are for preterm infants
Masks
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• Make sure the airway is clear
• Lift the baby’s jaw into the mask
• Keep the mouth slightly open
Rate 40-60
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Indications for Intubation
• Meconium and baby is not vigorous
• PPV by bag-mask does not result in good chest rise
• PPV needed beyond a few minutes
• Chest compressions necessary
• Route to administer epinephrine
• Special indications: Prematurity, CDH
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Miller 0
Miller 1
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3.5
3.0
2.5
Stylet
>2000 gm
1000-2000 gm
<1000 gm
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Intubation Technique
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Lip reference mark: (6 + weight in kilos) cm
9-10 cm at the lip for this term infant
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Indications for Compressions
• Heart rate <60 bpm after 30sec of PPV
• Coordinate with ventilation– 4 events in 2 seconds
– 90 compressions and 30 breaths per minute
One and Two and Three and Breathe2 seconds
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Compressions
2 thumb technique preferred
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Medications: Epinephrine• Indication: Heart rate <60 after 30 sec of
coordinated ventilation and compressions• 1:10,000 (0.1mg/ml)• Route: ETT or IV• 0.1-0.3 ml/kg
– 1ml Term– 0.5ml Preterm– 0.25ml Extreme preterm
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Extended Algorithm
• Endotracheal Intubation if not already accomplished
• Establish IV access with UVC
• Stat CXR• Discontinue efforts if
no heart rate after 15 minutes
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IV Access: “Low” UVC
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Volume
• Indication: No response to resuscitation and evidence of blood loss
• Normal Saline– Ringers or Blood as alternatives
• 10 ml/kg, may repeat
• Route: IV (Umbilical vein)
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Sodium Bicarbonate
• Indication: Documented or assumed metabolic acidosis
• Concentration: 4.2% NaHCO3 (0.5meq/ml)
• Dose: 2meq/kg
• Route: IV (Umbilical vein)
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Naloxone (Narcan)
• Indication: Severe respiratory depression after PPV has restored a normal HR and color and…– History of maternal narcotic administration
within the past 4 hours
• Dose: 0.1mg/kg of 1mg/ml solution
• Route: ETT, IV, IM, SQ
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Hypoglycemia
• Blood Glucose <45-60 –5cc/k D10W
–Route IV