RESUSCITATION OF THE NEWBORN

RESUSCITATING A LUNG THAT IS YET TO BE AERATED

requires higher pressure as compared to a previously ventilated lung

The APGAR score in one minute determines the need for resuscitation
Sign 0 Points 1 Point 2 Points
Appearance Blue all over Pink torso, blue
extremities
Pink torso &
extremities
Pulse Absent <100 bpm >100 bpm
Grimace No response to
stimuli
Limited cry Vigorous cry
Activity Flaccid Limited movement Actively moving
Respiratory
Effort
Absent Hypoventilation, irregular Strong loud cry

1 minute APGAR score
0-4 Severe depression, requiring immediate resuscitation
5-7 Some nervous system depression
8-10 normal

CARDIOPULMONARY ADAPTATION

INTRAUTERINE: The newborn breathes by utilizing placental oxygen.
AFTE R DELIVERY: The newborns first challenge is to breathe independently.

At birth, the baby's lungs are filled with amniotic fluid and are not inflated.
As the newborn is expelled from the birth canal, its central nervous system
reacts to the sudden change in temperature and environment.
This triggers it to take the first breath, within about 10 seconds after delivery.
With the first breaths, there is a fall in pulmonary vascular resistance, and an
increase in the surface area available for gas exchange.
Over the next 30 seconds the pulmonary blood flow increases and is oxygenated
as it flows through the alveoli of the lungs.











PRENATAL OR PERINATAL RISK FACTORS FOR NEONATAL ASPHYXIA

Antepartum Reasons to Suspect a
Depressed or Aphyxiated Newborn
Intrapartum Reasons to Suspect a
Depressed or Asphyxiated Newborn
Maternal age <16 or >35 yrs Abnormal fetal heart rate
- fetal bradycardia
- non-reassuring fetal heart rate patterns
Maternal diabetes Meconium stained fluid
Maternal hypertension Polyhydramnios
Pregnancy-induced hypertension Abnormal presentation
Chronic maternal illness Premature labor
Maternal hemorrhage Prolonged labor (>24 hrs)
Maternal infection Prolonged 2
nd
stage (>2 hrs)
Premature rupture of membranes Cord prolapsed
Maternal drug therapy Use of general anesthesia
Maternal drug dependence Emergency caesarean section
Polyhydramnios / oligohydramnios Forceps or vacuum-assisted delivery
Anemia / isoimmunisation Breech / other abnormal presentation
Previous Rh sensitization Foul smelling amniotic fluid
Post-term gestation Chorioamnionitis
Multiple gestation Abruption placentae
Size-dates discrepancy Placenta previa
Previous stillbirth Prolonged rupture of membranes (>18 hrs
before delivery)
Fetal malformation Uterine tetany
Diminished fetal activity
No prenatal care

EFFECTIVE RESUSCITATION
Prevents morbidity and mortality associated with hypoxic-ischemic encephalopathy and
hypoxic complication especially affecting the brain, heart and kidneys.
Brain hypoxia for 3-4 mins can lead to irreversible brain damage

MAIN GOAL OF RESUSCITATION:
To establish an adequate spontaneous respiration and cardiac output at the soonest
possible time.

INFANT WHO REQUIRES IMMEDIATE RESUSCITATION
( without bothering to do the APGAR scoring )
born limp
cyanotic
apneic
pulseless




ABCs OF RESUSCITATION
guiding rule in resuscitating a depressed newborn

AIRWAY
must be immediately cleared of any matter such as fluid and blood
meconium-stained amniotic fluid must be completely suctioned before positive
breathing can be applied or before positive breathing can be applied or before the
infant makes a gasping attempt
RECOMMENDED: the OB should suction the oropharynx as soon as the babys head is
delivered and before the shoulders are delivered
IN CASE THE INFANT IS MAKING SOME RESPIRATORY EFFORT
NOTE FOR: Stridor and suprasternal retractions
R/O choanal atresia
BREATHING
initiated either with bag and mask or with direct endotracheal intubation
ambubag for 60-80/minute when there is poor response to ventilation
endotracheal intubation: performed in infants who do not respond to initial bag and
mask ventilation


CIRCULATION
may require cardiac massage

DRUGS
Naloxone:
if the mother received narcotics
0.1 mg/kg IV or intratracheally

ENVIRONMENT: thermal environment
Infant should be placed under a radiant heater or any heat source
Should be immediately dried
Head positioned downwards and slightly extended

METABOLIC ACIDOSIS
Persistent bradycardia despite adequate ventilation
NaHCO3
3 mEq/kg

CHEST COMPRESSION
HR: below 80 bpm after manually ventilating the infant
CURRENT RECOMMENDATION:
place the two thumbs on the middle of the sternum
below an imaginary line between the nipples
the rest of the fingers encircling the chest
depth: 1/2 - 2/3 inch
rate: 120/min
compression/ventilation ratio: 3:1
most effective treatment for hypoxia: ventilation with 100% oxygen
Epinephrine
Asystole
0.1-0.3 ml/ kg
IV or intratrachel
May be repeated every 5 minutes
If unresponsive: use 5-10x the standard dose of epinephrine

Plasma volume expanders
Blood, 5% albumin, LR, NSS
Hypovolemic shock, hypotension or weak pulses
10ml/kg

Sodium bicarbonate
1-2 mEq/kg
0.5 mEq/ml of a 4.2% solution
Given slowly
If the resuscitation is prolonged and there is persistent metabolic acidosis
Should always be diluted with equal amounts of IV fluid

DOPAMINE or DOBUTAMINE
Cardiogenic shock secondary to severe asphyxia
Continuous infusion
5-20 ug/kg/min

AFTER SUCCESSSFUL RESUSCITATION
In the NICU:
Infants multiple organ functions must be monitored closely regardless of the
severity of asphyxia or response to resuscitation