MIDTERMS
LESSON 1
MaRTINa MEDRaNO
NEWBORN RESUSCITATION
INTRODUCTION
29% of neonatal deaths are caused by
prenatal hypoxia.
Hypoxia -a condition where the tissue
level oxygen supply is insufficient to
maintain adequate homeostasis.
Asphyxia -a condition where there is a
lack of oxygen in the body, typically
brought on by breathing problems or a
lack of oxygen, which results in
unconsciousness and frequently
fatalities.
NEWBORN RESUSCITATION
-is a Basic Life Support needed for
patient whose breathing or heart has
stopped
Ventilations are given to oxygenate
blood when breathing is inadequate
or has stopped
If heart has stopped, chest
compressions are given to circulate
blood to vital organs.
Ventilation combined with chest
compressions is called
cardiopulmonary resuscitation (CPR)
OCPR is commonly given to patients
in cardiac arrest as a result of heart
attack.
Indications for Resuscitation:
a) Antepartum factors
b) Intra partum factors
c) Post partum factors
ANTEPARTUM FACTORS:
➢ Maternal diabetes
➢ Maternal infections
➢ Hydromnias
➢ Post term gestation
➢ Maternal drug abuse (like
respiridine, lithium, carbonate
INTRANATAL FACTORS: Abnormal
presentations.
➢ Premature labor.
➢ Early rupture of membranes.
➢ Foul smelling amniotic fluid.
➢ Precipitate labor.
➢ Fetal bradycardia.
➢ Cord prolapse.
➢ Meconeum stained amniotic
fluid.
➢ Narcotic administration to
mother with in 4 hrs of
delivery.
ABC's of Resuscitation
A B C (A: Airway, B: Breathing, C:
Circulation)
A - establish open airway Position,
suction
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B- initiate breathing by Tactile 4. Timely recognition, Quick and
stimulation, Oxygen correct action are critical for the
success of resuscitation.
C- maintain circulation Chest
compression
D- Medications Anticipation of resuscitation
Initial steps: Resuscitation must be anticipated at
every birth.
-Thermal management
Every birth attendant should be
-Positioning
prepared and able to resuscitate.
-Suctioning
-Tactile stimulation

Adequate preparation for

resuscitation:
1. A self-inflating Ambu bag
(newborn size)
2. Two infant masks (for normal and
small newborn),
3. A suction device (mucus extractor),
4. A radiant heater (if available),
warm towels, a blanket and
5. A clock are needed
Initial stabilization and evaluation
This consists of:
➢ drying, (thermal management)
1.Anticipation. ➢ positioning the neonate under
radiant warmer to minimize
2.Adequate preparation.
heat loss,
3. Initial stabilization and evaluation. ➢ suctioning of mouth and nose
(Tracheal suctioning if
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LESSON 1
MaRTINa MEDRaNO
meconium present) and provide
tactile stimulation.
This should only take approximately
20 seconds.
(1) Open the airway
Put the baby on its back Position the
head so that it is slightly extended.
Rationale: The upper airway (the
mouth then the nose) should be
suctioned to remove fluid if stained
with blood or meconium.
(2) If there is no cry, assess
breathing:
If the chest is rising symmetrically
with frequency >30/minute,
no immediate action is needed.
If the newborn is not breathing or
gasping
Immediately start resuscitation. There
are two techniques to provide
breathing:
1.Technique for artificial respiration
2.Positive pressure ventilation.
1.Technique for artificial respiration
CLEAR THE MOUTHOF
MUCOUS.
HYPER EXTEND THE NECK
WITH ONE HAND, CLAMP THE
NOSTRILS WITH FINGERS OR
SEAL NOSE AND MOUTH OR
NOSE ONLY
TAKE DEEP BREATH AND FORCE
AIR INTO LUNGS.
When no equipment is available:
mouth to mouth-and-nose breathing
should be done.
Positive pressure ventilation
The most important aspect of
newborn resuscitation
for ensuring adequate ventilation of
the lungs, oxygenation of vital organs,
and initiation of spontaneous
breathing.
Ventilation can almost always be
initiated using a bag and mask. 2 basic
kinds of resuscitation bags are
available.
Self-inflating bag
Flow inflating bag
(it is rarely necessary to intubate)
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LESSON 1
MaRTINa MEDRaNO
OUT LINE PROCEEDURE TO
VENTILATE
➢ Select the appropriate mask
➢ Reposition the newborn
➢ Make sure that the neck is
slightly extended.
➢ Place the mask on the
newborn's face, so that it covers
the chin, mouth and nose.
➢ Form a seal between the mask
and the infant's face. Squeeze
the bag with two fingers only.
➢ There should be noticeable rise
and fall of chest with each
inflation.
EVALUATE THE HEART RATE
After 30 sec, count the heart rate for
6sec and multiply it by 10 to obtain
heart rate per mt. If the HR is
>100bpm and infant has spontaneous
respirations discontinue ventilation,
provide tactile stimulations and free
flow oxygen. If HR is <100 bpm
ensure ventilation with 100% oxygen
initiate chest compression.
CHEST COMPRESSION:
Whenever the HR remains < than
60bpm inspite of positive pressure
ventilation.
2 types:
I. THUMB TECHNIQUE
II.TWO FINGER TECHNIQUE
Pressure to be applied vertically.
Cannot use effectively if the baby is
large or if our hands are small.
Position of the baby on firm surface
with neck slightly extended.
Location:
lower third of sternum which lies
between the xyphoid and the line
drawn between nipples.
Depth of compression:
Infant: 1/2-3/4"
Child:1-1/2"
Compression and ventilation rates and
ratios: For adult-30 compression and
2 breaths. For infant and child-15:2.
CHEST COMPRESSIONS:
• Place thumbs of both hands on
sternum while fingers encircle chest
• Compress breastbone with both
thumbs while fingers support the
back.
• After effectively ventilating for
about 1 minute, stop briefly but do not
remove the mask and bag and look for
spontaneous breathing
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MaRTINa MEDRaNO
• If there is none or it is weak,
continue ventilating until spontaneous
cry/breathing begins.
• If breathing is slow (frequency of
breathing is <30), or if there is severe
chest indrawing:
• Continue ventilating and ask for
arrangement for referral if possible.
• A newborn will benefit from transfer
only if it is properly ventilated and
kept warm during transport
Remember: If there is no gasping or
breathing at all after 20 minutes of
ventilation:
-Stop ventilation.
Care after successful resuscitation:
➢ Do not separate the mother and
the newborn.
➢ Leave the newborn skin-to-skin
with the mother.
➢ Encourage breast-feeding
within one hour of birth.
➢ The newborn that needs
resuscitation is at higher risk of
developing hypoglycemia.
➢ Observe suckling.
➢ Good suckling is a sign of good
recovery.
Drugs are seldom needed to:
1. Stimulate the heart so that it
supplies oxygen, nutrition to the body
and vital organs.
2. Increase tissue perfusion
3. Restore acid-base balance.
4. Correct acidosis.
They may be required in newborns
who do not respond to adequate
ventilation with 100% oxygen and
chest compressions.
Sodium bicarbonate
Sodium bicarbonate is not
recommended in the immediate
postnatal period if there is no
documented metabolic acidosis.
It should therefore not be given
routinely to newborns who are not
breathing If it is given administer
2meq/kg
Umbilical vein
Slowly not faster than a rate of
1meq/kg/mt.
Epinephrine
Epinephrine in a dose of 0.01-0.03
mg/kg should be administered if the
heart rate remains <60 bpm after a
minimum of 30 seconds of adequate
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ventilation and chest compressions.
Routes: umblical vein, endotracheal,
intravenous.
Volume expanders NS &RL
10ML/KG UMBLICAL VEIN TO BE
INFUSED OVER 5-10 MTS.
NALOXINE HYDRO CHLORIDE
1.0mg/ml solution intravenous.
Intraosseous access can serve as an
alternative route for
medications/volume expansion if
umbilical or other direct venous
access is not readily available.