NEWBORN
RESUSCITATION
Belen Amparo E. Velasco, M.D.
ASSESS AND SUPPORT
TEMPERATURE (warm and dry)
ABC’s
AIRWAY (position and suction)
BREATHING (stimulate to cry)
CIRCULATION (heart rate and
color
INVERTED PYRAMID
In NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
Chest
Compression
Medications
PREPARATION
ADVANCED PREPARATION
IMMEDIATE PREPARATION
ADVANCED
PREPARATION
OBSTETRICAL TRAY
NB RESUSCITATION TRAY
RADIANT WARMER/DROPLIGHT
NB RESUSCITATION
EQUIPMENT
Bulb syringe
Endotracheal tube (2.5, 3.0, 3.5) and stylets
Face masks and ambubag
Feeding tubes
Gowns, gloves, goggles
Heat source
Laryngoscope handles and blades
Meconium aspirator
Medications and fluids
Sterile UC set
Suction with manometer/catheters
Syringes (1, 3, 10 and 20 ml)
Warmed blankets
IMMEDIATE
PREPARATION
BASED ON RESUSCITATION
-ORIENTED HISTORY
VERIFICATION OF AIRWAY
PATENCY AND PLACEMENT
OF VASCULAR CATHETERS
RESUSCITATIONORIENTED HISTORY
MECONIUM STAINING
PREMATURITY
TWIN PREGNANCY
NARCOTICS ADMINISTRATION
TO MOTHER
FACTORS ASSOCIATED WITH
INCREASED RISK FOR
NEONATAL DEPRESSION
ANTEPARTUM MATERNAL FACTORS
INTRAPARTUM MATERNAL OR
FETAL FACTORS
ANTEPARTUM
MATERNAL FACTORS
Maternal age > 35 or < 18
Chronic and pregnancy-induced HPN
Diabetes
Hemorrhage
Drug therapy (Mg, lithium,
adrenergic-blockers
Substance abuse
Previous abortion
No prenatal care
Anemia or isoimmunization
ANTEPARTUM
MATERNAL FACTORS
Maternal illness (CV, thyroid,
neurologic)
Multifetal gestation
Small fetus for maternal dates
Post-term fetus
Preterm labor or PROM
Immature pulmonary studies
Oligohydramnios
Diminished fetal activity
Fetal malformation by UTZ
INTRAPARTUM MATERNAL
OR FETAL FACTORS
Breech or other abnormal presentation
Infection
Prolonged labor
Prolonged rupture of membranes
Prolapsed cord
Maternal sedation
Operative delivery
Meconium-stained AF
Indices of fetal distress
UNIVERSAL
PRECAUTIONS
GLOVES AND OTHER APPROPRIATE
PROTECTIVE BARRIERS (gowns and
goggles)
SUCTION EQUIPMENT SHOULD
ALWAYS BE AVAILABLE
INVERTED PYRAMID
In NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
Chest
Compression
Medications
INITIAL STEPS OF
RESUSCITATION
(20 seconds)
PREVENTION OF HEAT LOSS
PROPER POSITIONING
SUCTIONING
TACTILE STIMULATION
TEMPERATURE
REGULATION
HEAT LOSS MAY BE PREVENTED BY
REMOVING WET LINENS
DRYING THE BABY
PLACING INFANT UNDER
PREHEATED LAMP/RADIANT
WARMER
TEMPERATURE
REGULATION
ALTERNATIVE METHODS OF WARMING:
WARM BLANKETS/TOWELS
WARM MATTRESSES
AIRWAY
POSITIONING
PLACEMENT ON BACK OR SIDE WITH
NECK IN NEUTRAL POSITION
SHOULDER ROLL (3/4 OR 1 inch) to
EXTEND NECK SLIGHLY
AIRWAY
SUCTIONING
IF MECONIUM-STAINED, TRACHEAL
SUCTIONING
BULB SYRINGE SHOULD BE ADEQUATE
IF NOT MECONIUM-STAINED,
SUCTION MOUTH FIRST THEN
NOSTRILS
AIRWAY
SUCTIONING
MAY USE MECHANICAL SUCTION
WITH 8F OR 10F SUCTION
CATHETERS AT NEGATIVE
PRESSURE NOT TO EXCEED
-100mmHg FOR NO LONGER
THAN 3 to 5 seconds PER
ATTEMPT
TACTILE
STIMULATION
SLAPPING OR FLICKING THE SOLES
GENTLE RUBBING OF THE BACK
ASSESSMENT
RESPIRATORY EFFORT
HEART RATE
COLOR
INVERTED PYRAMID
In NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
Chest
Compression
Medications
OXYGEN
100% OXYGEN SHOULD BE USED
PREFERABLY WARMED AND
HUMIDIFIED
FREE-FLOW O2 BY O2 HOOD
OR BY FACE MASK ATTACHED TO
AMBUBAG OR SIMPLE MASK
HELD TO FACE WITH 5L/min O2
FLOW
INVERTED PYRAMID
In NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
Chest
Compression
Medications
POSITIVE-PRESSURE
VENTILATION
INDICATIONS
APNEA OR GASPING RESPIRATION
HEART RATE LESS THAN 100 bpm
PERSISTENT CENTRAL
CYANOSIS 100% OXYGEN
POSITIVE-PRESSURE
VENTILATION
• USUALLY PROVIDED WITH BAG
AND MASK
•
VENTILATORY RATE of 40-60/min
INVERTED PYRAMID
In NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
Chest
Compression
Medications
CHEST
COMPRESSION
INDICATIONS
Persistent
bradycardia
(6080/min not increasing) despite 30
seconds
of
positive
pressure
ventilation
CHEST
COMPRESSION
CHEST COMPRESSION AT A RATIO
with BAGGING OF 1:3 (Total of 120
events)
TWO METHODS:
Thumb method
Two-finger method
INVERTED PYRAMID
In NB Resuscitation
Dry, Warm, Position, Suction, Stimulate
Oxygen
Establish effective ventilation
Chest
Compression
Medications
MEDICATIONS
EPINEPHRINE
INDICATIONS
Heart rate of zero
Persistent
bradycardia
(<60/min)
despite
30
seconds of positive pressure
ventilation and 30 seconds
of chest compression
MEDICATIONS
VOLUME EXPANDERS
INDICATIONS
Acute blood loss
Non-improvement despite
adequate resuscitation
MEDICATIONS
SODIUM BICARBONATE
INDICATIONS
Documented metabolic
acidosis
Cardiac arrest
MEDICATIONS
NALOXONE
INDICATIONS
Respiratory depression with
maternal history of narcotic intake
within four hours from the
time of delivery