LEARNING GUIDE OF NEONATAL RESUSCITATION

STEP I: GETTING READY

1. Position of the Baby

Place the baby on his/her back on the flat surface.

Position the head so that the neck is slightly extended. Put a rolled cloth under the shoulder to maintain the position.

The resuscitation surface should be well lit and warm

Keep the babys head and lower body covered to keep him/her warm except for the face and upper chest.

2. Clear the Airway

Wipe off the babys face with a clean piece of gauze or cloth.

Clear the airway by suctioning the mouth first and then the nostrils.

Introduce catheter into the babys mouth and suction while withdrawing.

Introduce catheter into each nostril and suction while withdrawing catheter.

If blood or meconium is in the babys mouth or nose, suction immidiately to prevent aspiration.

Dont suction deep in the throat as this may cause the babys heart to slow or the baby may stop breathing.

3. Give oxygen (as necessary and if available).

4. Reasses the babys breathing, heart rate (feel for cord pulsation, count for 6 seconds and multiply by 10. If no pulse is felt check for heart rate using stethoscope) and color.

If the baby is breathing, heart rate is above 100, the baby is pink and has good tone baby may be given to mother for warmth, breast feeding and love.

If the baby is breathing, heart rate is above 100 but baby is blue or pale, keep baby warm, stimulate and give oxygen. (if available)

If the baby is not breathing or is gasping or the heart rate is below 100, start ventilating the baby.

STEP II: VENTILATING WITH BAG AND MASK

1. Make sure baby has neck slightly extended.

2. Place the mask on the babys face so that it covers the chin, mouth and nose,

3. Form a seal between the mask and the infant's face. (Size1 mask for normal weight newborn and size 0 for a small newborn).

4. Squeeze the bag with two fingers only (adult size) or with the whole hand (newborn size bag) depending on the size of the bag.

5. Ventilate the baby 2 times

6. Use enough pressure to squeeze the bag so that you see a gentle rise and fall of the chest.

7. If the babys chest is rising, ventilate the baby 20-30 times in 30 seconds.

8. If the babys chest is not rising:

Check the position fo the head again to make sure the neck is slightly extended.

Reposition the mask on the babys face to improve the seal between mask and face.

Squeeze the bag with the whole hand to increase ventilation pressure and

Repeat suction of mouth and nose remove mucus, blood or meconium from the airway.

9. After each 30 seconds of ventilation, reasses the babys breathing, heart rate and color:

If the baby breathes spontaneously and his heart rate is >100, stop resuscitation. Continue to give supportive care.

If the baby is not breathing or is gasping or the heart rate is below 100 continue to ventilate 20-30 times in 30 seconds and then re-evaluate.

If the heart rate is below 60, continue to ventilate the baby and begin chest

compressions.

STEP III: CHEST COMPRESSION WITH VENTILATION

1. Two fingers are placed just below the nipple line.

2. Two hands encircling the chest and two thumbs at the nipple line the depress 1/3 of the anterior-posterior diameter of the chest 3 times.

3. Ventilate the baby after 3 chest compressions (Avoid giving a compression and ventilation at the same time).

4. Count a loud while you push, 1 and 2 and 3 and breathe. This will keep a rhythm and if there is a person doing the breaths, they will know when to ventilate or breathe for the baby.

5. Do 15 cycles (1 cycle = 3 compression and breath) of chest compressions with ventilation.

6. Evaluate the babys heart rate after each 15 cycles:

If the heart rate is 60 : stop compressions and continue to ventilate the baby.

If the heart rate is >100 and baby is breathing on his own: stop ventilating and continue to support the baby with warmth, oxygen and stimulation until pink and active.

PROCEDURE OF NEONATAL RESUSCITATION

STEP I: GETTING READY

5. Position of the Baby

Place the baby on his/her back on the flat surface.

Position the head so that the neck is slightly extended. Put a rolled cloth under the shoulder to maintain the position.

The resuscitation surface should be well lit and warm

Keep the babys head and lower body covered to keep him/her warm except for the face and upper chest.

6. Clear the Airway

Wipe off the babys face with a clean piece of gauze or cloth.

Clear the airway by suctioning the mouth first and then the nostrils.

Introduce catheter into the babys mouth and suction while withdrawing.

Introduce catheter into each nostril and suction while withdrawing catheter.

If blood or meconium is in the babys mouth or nose, suction immidiately to prevent aspiration.

Dont suction deep in the throat as this may cause the babys heart to slow or the baby may stop breathing.

7. Give oxygen (as necessary and if available).

8. Reasses the babys breathing, heart rate (feel for cord pulsation, count for 6 seconds and multiply by 10. If no pulse is felt check for heart rate using stethoscope) and color.

If the baby is breathing, heart rate is above 100, the baby is pink and has good tone baby may be given to mother for warmth, breast feeding and love.

If the baby is breathing, heart rate is above 100 but baby is blue or pale, keep baby warm, stimulate and give oxygen. (if available)

If the baby is not breathing or is gasping or the heart rate is below 100, start ventilating the baby.

STEP II: VENTILATING WITH BAG AND MASK

10. Make sure baby has neck slightly extended.

11. Place the mask on the babys face so that it covers the chin, mouth and nose,

12. Form a seal between the mask and the infant's face. (Size1 mask for normal weight newborn and size 0 for a small newborn).

13. Squeeze the bag with two fingers only (adult size) or with the whole hand (newborn size bag) depending on the size of the bag.

14. Ventilate the baby 2 times

15. Use enough pressure to squeeze the bag so that you see a gentle rise and fall of the chest.

16. If the babys chest is rising, ventilate the baby 20-30 times in 30 seconds.

17. If the babys chest is not rising:

Check the position fo the head again to make sure the neck is slightly extended.

Reposition the mask on the babys face to improve the seal between mask and face.

Squeeze the bag with the whole hand to increase ventilation pressure and

Repeat suction of mouth and nose remove mucus, blood or meconium from the airway.

18. After each 30 seconds of ventilation, reasses the babys breathing, heart rate and color:

If the baby breathes spontaneously and his heart rate is >100, stop resuscitation. Continue to give supportive care.

If the baby is not breathing or is gasping or the heart rate is below 100 continue to ventilate 20-30 times in 30 seconds and then re-evaluate.

If the heart rate is below 60, continue to ventilate the baby and begin chest

compressions.

STEP III: Oxygen

Additional oxygen is not necessary for basic resuscitation , although it has been considered so by some practitioners.

Moreover, new evidence from a controlled trial shows that : most newborns can be successfully resuscitated without additional oxygen

However, when the newborn's color does not improve despite effective ventilation, oxygen should be given if available.

STEP IV: CHEST COMPRESSION WITH VENTILATION

7. Two fingers are placed just below the nipple line.

8. Two hands encircling the chest and two thumbs at the nipple line the depress 1/3 of the anterior-posterior diameter of the chest 3 times.

9. Ventilate the baby after 3 chest compressions (Avoid giving a compression and ventilation at the same time).

10. Count a loud while you push, 1 and 2 and 3 and breathe. This will keep a rhythm and if there is a person doing the breaths, they will know when to ventilate or breathe for the baby.

11. Do 15 cycles (1 cycle = 3 compression and breath) of chest compressions with ventilation.

12. Evaluate the babys heart rate after each 15 cycles:

If the heart rate is 60 : stop compressions and continue to ventilate the baby.

If the heart rate is >100 and baby is breathing on his own: stop ventilating and continue to support the baby with warmth, oxygen and stimulation until pink and active.

STEP - VI: Endotracheal intubation

This has been shown to provide more effective ventilation in severely depressed/ill newborns.

It is more convenient for prolonged resuscitation but is also a more complicated procedure that requires good training.

STEP VII: Drugs

1. Epinephrine:

Indications: HR