Neonatal Abstinence Syndrome (NAS) in Neonatal Intensive ...
NEONATAL RESUSCITATION.ppt
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Transcript of NEONATAL RESUSCITATION.ppt
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NEONATAL RESUSCITATIONRachel Musoke University of NairobiKNH/UON SYMPOSIUM 10TH Jan 2013
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Poor intrapartum fetal oxygenation Also referred as asphyxiaCommon cause of death & long term disability (mental & neurological)Estimated to contribute to 9% of all < 5 mortality (MDG 4)Burden of disease assessment 42 million disability-adjusted life years (DALYs)
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Contributing factorsThe delaysDelay in recognition of the problem in the motherDelay in transportation to a medical facilityDelay in providing appropriate care at the health facility
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Solutions to reduce deaths & disability
Primary prevention maternal care (early recognition & management)Secondary prevention appropriate neonatal resuscitationTertiary prevention recognition & management of acute complications
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The Global Need for neonatal Resuscitation, FIGO, Wall et al
The Global Need for neonatal Resuscitation, FIGO, Wall et al
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Which babies need resuscitation?Assess: Gestation term or preterm?Breathing or Crying?Good tone?If NO then act quicklyThe first golden minute
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The ABC of resuscitationAirway (Position and clear)Breathing (stimulate to breathe)Circulation (Majority of babies have normal hearts)
Warmth
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Breathing
Ventilation of babys lungs is the most important and effective action in neonatal resuscitation
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Room air vs.O2 for ResuscitationTerm InfantsPre-Term Infants(< 32 weeks)
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Room air or oxygen?Term infants: Mortality lower with room air vs 100% O2Shorter recovery
PretermBalance the needs for oxygen vs possible toxicity
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Oxygen saturations at birth
1 minute60-65%
2 minutes65-70%
3 minutes70-75%
4 minutes75-80%
5 minutes80-85%
10 minutes85-95%
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Meconium stained liquor
Clear mouth & nose before drying & stimulation to avoid aspiration
Suctioning of the trachea reserved for nonvigorous babies
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EquipmentsWarmth towels & heaterAirway suction cathetersVentilate bag (500ml). & masks (sizes)Source of oxygen (& blender)Auscultate stethoscopePulse oximeter (if possible)Intubation equipment
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Key behavior skillsKnow your environmentAnticipate & planCall for help & work as a teamThe person present must initiate resuscitationCommunicate effectivelyUse all available resources
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SUMMARY
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Effective ResuscitationAirway & BreathingCirculationDrugs
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SummaryEverybody who conducts a delivery must be able to resuscitate
We should be prepared at all times
Lets give our newborn a good start
Comparable to malaria. 78-90% die in 1st 48hrs of delivery. 25-29% of survivors have moderate to severe impairment Double that due to diabetes & almost of burden due to HIV/AIDS. **
There are concerns about potential adverse effect of 100% oxygen on breathing physiology, cerebral circulation, and potential tissue damage from oxygen free radicals.
The new recommendations are divided into two groups by gestational age: Term and Pre-Term (