NEWBORN

RESUSCITATION
 CORE KNOWLEDGE & SKILLS
 Establish clear airway
 Support adequate ventilation & oxygenation
 Maintain adequate cardiac output
 Reduce heat loss
 EFFECTIVE TRIAGE
 Ideally births should take place in the delivery
or birthing room
 Avoid delays in the field or emergency
department
PHASES OF RESUSCITATION
 Preparation
 Resuscitation
 Post Resuscitation
 PREPARATION
 Advanced
 Immediate
 RESUSCITATION ASSIGNMENTS

 Team leader: airway

 Second rescuer: pulse check
chest compressions
 Third rescuer: medications
equipment
 Resuscitation Oriented History
 Multiple pregnancy
 Meconium stained fluid
 Prematurity
 Narcotic use in previous 4 hours
Clear of meconium
Routine care
Breathing or crying
YES Provide warmth
Good muscle tone
Clare airway
Color pink
Dry
Term gestation

Provide warmth
Position, clear airway (as necessary)
Dry, stimulate, reposition
Give O2 (as necessary)

Breathing
Evaluate respirations Supportive Care
heart rate and color
HR > 100 and pink
 Apnea or HR < 100
Ventilating
Provide positive pressure
ventilation Ongoing Care
HR > 100 and pink

HR < 60 HR > 60

Provide positive ventilation

Administer chest compressions

Administer epinephrine
                                                                                                                                                                                       
 INDICATIONS FOR BAG VALVE
MASK VENTILATION
 Apnea or gasping respirations
 Heart rate < 100 bpm
 Persistent cyanosis despite oxygen therapy
 VENTILATION IN THE NEWBORN

 Assisted rate – 40 – 60 breaths per minute

 Signs of adequate ventilation
 Bilateral chest expansion
 Bilateral breath sounds
 Adequate heart rate,colour
 INDICATIONS FOR INTUBATION

 Bag valve mask ventilation is ineffective

 Thick meconium is present
 Prolonged positive pressure ventilation is
required
 INDICATIONS FOR CHEST
COMPRESSIONS
 Despite adequate stimulation and effective
ventilation with 100% oxygen
Heart rate < 60bpm
NEONATAL CHEST COMPRESSIONS

 Rate : 120 per minute interposed with

ventilations
 Compression ventilation ratio : 3:1
 Stop compressions when heart rate is > 80
bpm
SPECIAL SITUATIONS
MECONIUM ASPIRATION

DIAPHRAGMATIC HERNIA
 SPECIAL CONSIDERATIONS
 MAS – Vigorous VS Non Vigorous
 Vigorous determined by tone ,respiration &
colour
Proceed with initial steps
Non vigorous – Direct tracheal suctioning
Diaphragmatic hernia – NO BVM
Nasogastric decompression
MEDICATIONS
 EPINEPHRINE
 Indication : Heart rate < 80 bpm despite
positive pressure ventilation and chest
compressions
 Dose: 0.01-0.03mg/kg IV,ET,IO(0.1-0.3ml/kg
of 1:10,000)
 If no response to ET administration,may
increase ET dose to up to 0.1mg/kg(0.1ml/kg
of 1:1000)
 NALOXONE
 Indication :
 Respiratory depression
 Recorded narcotic
administration within 4 hrs of
delivery.
Dose
 CAUSES OF ACUTE DETERIORATION IN
THE INTUBATED INFANT
 Displaced endotracheal tube
 Obstructed endotracheal tube
 Pneumothorax
 Equipment failure PLUS
 -Inadequate ventilatory support
 -Gastric distention
 POST RESUSCITATION EVALUATION & CARE

 Temperature regulation
 Acid Base Status
 Blood Glucose
 Laboratory Studies
 Chest Xray
                                                                                                                                                                                       
PREVENTION OF NEUROLOGIC SEQUALE

1. Development Assessment at 1,3,6,9,12 months

2. Assessment of Early Indicators of CP

3. Early Identification of sequale and specific

treatment and rehabilitation
 Mortality Statistics for the Month of Jan-09
INBORN Ward
Preterm
Total No. of Admissions 224 ELBW/RDS 1
Total No. of AMA/Death 32 ELBW/Apnea 1
Percentage of AMA/Death 14.3% VLBW/RDS 5
Break up Preterm 18 VLBW/NEC 1
Term 14
According to Birth Weight VLBW/Hydrocephalus 1
Babies weighing < 1000gms 2 VLBW/B.Asphyxia 2
Babies weighing 1000-1500 gms 9 LBW/B.Asphyxia 6
Babies weighing 1500-2000 gms 8 LBW/Apnea 1
Babies weighing 2000-2500 gms 2 Term
Babies weighing 2500-3000 gms 9 B.Asphyxia HIE III 6
Babies weighing >3000 gms 2 B.Asphyxia HIE II 1
According to mode of delivery MAS/B.Asphyxia HIE III 4
LSCS 8 MAS/B.Asphyxia HIE II 1
LN 18 Cyanotic Cery. Heart Disease 2
INSTRUMENTAL Breech 5
Forceps 1
 Mortality Statistics for the Month of Feb-09
INBORN Ward
Preterm
Total No. of Admissions 166 ELBW/RDS 2
Total No. of AMA/Death 29 ELBW/Apnea 2
Percentage of AMA/Death 17.5% VLBW/RDS 3
Break up Preterm 18 VLBW/Apnea 1
Term 11
According to Birth Weight VLBW/Septicemia 1
Babies weighing < 1000gms 4 VLBW/B.Asphyxia 6
Babies weighing 1000-1500 gms 11 LBW/B.Asphyxia 4
Babies weighing 1500-2000 gms 5 LBW/Apnea -
Babies weighing 2000-2500 gms 3 Term
Babies weighing 2500-3000 gms 4 B.Asphyxia HIE III 1
Babies weighing >3000 gms 2 B.Asphyxia HIE II -
According to mode of delivery MAS/B.Asphyxia HIE III 5
LSCS 9 MAS/B.Asphyxia HIE II 3
LN 15 MAS 1
INSTRUMENTAL Breech 4 Cong. Cyanotic Heart Disease 1
Forceps 1
 Mortality Statistics for the Month of March-09
INBORN Ward
Preterm
Total No. of Admissions 205 IUGR/VLBW/MAS/B.Asphyxia 1
Total No. of AMA/Death 24 Birth Asphyxia HIE II 1
Percentage of AMA/Death 11.7% VLBW/RDS/Pul.hgge 1
Break up Preterm 9 VLBW/NEC 1
Term 15
According to Birth Weight MAS/Birth Asphyxia HIE II 1
Babies weighing < 1000gms 1 VLBW/B.Asphyxia 1
Babies weighing 1000-1500 gms 6 LBW/B.Asphyxia 1
Babies weighing 1500-2000 gms 1 VLBW/Apnea 1
Babies weighing 2000-2500 gms 6 Term
Babies weighing 2500-3000 gms 9 B.Asphyxia HIE III 3
Babies weighing >3000 gms 1 MAS/B.Asphyxia HIE III 5
According to mode of delivery MAS/B.Asphyxia HIE II 3
LSCS 4 Birth Asphyxia with Cong. Diaphresm 1
Hernia
LN 11 Birth Asphyxia with Cong. Heart disease 1
INSTRUMENTAL Breech 2 Birth Asphyxia with VSD with Cleft 1
Forceps 6 Uppalbab
Cyanotic Cery. Heart Disease 1
Mortality Statistics for the Month of April-09 INBORN Ward
Preterm
Total No. of Admissions 165 ELBW/RDS 2
Total No. of AMA/Death 25 VLBW/RDS 1
Percentage of AMA/Death 15.15% VLBW/Apnea 1
Break up Preterm 12 VLBW/IVH 1
Term 13
According to Birth Weight VLBW/B.Asphyxia 2
Babies weighing < 1000gms 2 VLBW/Septicemia 1
Babies weighing 1000-1500 gms 6 LBW/B.Asphyxia 2
Babies weighing 1500-2000 gms 5 LBW/RDS 1
Babies weighing 2000-2500 gms 5 IUGR/LBW/Apnea 1
Babies weighing 2500-3000 gms 6 Term
Babies weighing >3000 gms 1 B.Asphyxia HIE III 2
According to mode of delivery B.Asphyxia HIE II 2
LSCS 4 MAS/B.Asphyxia HIE III 4
LN 14 MAS/B.Asphyxia HIE II 1
INSTRUMENTAL Breech 3 LBW/Septicemia 1
OutLet 4
LBW/Cyanotic Cery. Heart Disease 1
Neonatal Convulsion/IEM 1
 Mortality Statistics for the Month of May-09
INBORN Ward
Preterm
Total No. of Admissions 178 ELBW/RDS 1
Total No. of AMA/Death 32 ELBW/Apnea 1
Percentage of AMA/Death 17.9% ELBW/B.Asphyxia 1
Break up Preterm 16 VLBW/RDS 2
Term 16
According to Birth Weight VLBW/B.Asphyxia 4
Babies weighing < 1000gms 3 VLBW/Apnea 1
Babies weighing 1000-1500 gms 7 LBW/RDS 4
Babies weighing 1500-2000 gms 9 LBW/B.Asphyxia 2
Babies weighing 2000-2500 gms 6 Term
Babies weighing 2500-3000 gms 2 B.Asphyxia HIE III 3
Babies weighing >3000 gms 5 B.Asphyxia HIE II 2
According to mode of delivery MAS/B.Asphyxia HIE III 5
LSCS 4 MAS/B.Asphyxia HIE II 5
LN 23 Cyanotic Cery. Heart Disease 1
INSTRUMENTAL Breech 2
Forceps 3