Neonatal Resuscitation

Al kindy college of
Prepared by:
Sarah Emad Medicine
Shadan Khorsheed University of Baghdad
 Neonatal Resuscitation
Neonatal resuscitation skills are essential for all health care
Providers who are involved in the delivery of newborns.

- The transition from fetus to newborn requires intervention

In 10% of deliveries

-Perinatal asphyxia and extreme prematurity frequently

Necessitate complex resuscitation
Chinese emperor and philosopher Hwang‐Ti (2698–
2599 BC) noted that newborn death from ventilatory
failure occurred more commonly among infants born
prematurely

Increased mortality among premature infants was also

reported in Eber's Papyrus in Egypt (1552 BC),

Hippocrates (460–380BC) described intubation of the

trachea of humans to support ventilation.
 1960’s Mechanical ventilation

1970’s Neonatal intensive care units

 1985 NRP Neonatal resuscitation program

 1992 international collaboration

Embryonic stages of lung development
Fetal pulmonary physiology
At term, the fetal lung is filled with approximately 20 ml
Of fluid secreted by pulmonary epithelium

This fluid maintains lung volume at about FRC

 The placenta provides the respiratory function for the

fetus

 Fetal breathing begins at 11 weeks’ gestation

Neonatal pulmonary physiology
How lung fluid is removed ?!

 During delivery

 Thoracic compression
 Lymphatic drainage
 Readsorption

 After Birth
 evaporation
 lymphatics
 ion transport
Fetal circulation
• The umbilical vein carries the oxygenated blood
From the placenta to the fetus

• only 12% of the blood from the right ventricle enters

The lungs
Neonatal circulation

 Clamping of umbilical cord removes the low resistance

Placental vascular circuit and thereby raises systemic
Vascular resistance
Antepartum factors
 Maternal diabetes
 gestational hypertension or preeclampsia  post term gestation
 chronic hypertension  multiple gestation
 fetal anemia or isoimmunization  size-dates discripancy
 previous fetal or neonatal death  drug therapy
 bleeding in 2nd or 3rd trimester  maternal substance abuse
 maternal infection  fetal malformation
 maternal cardiac, renal, pulmonary, thyroid  diminished fetal activity
Or neurologic disease  no prenatal care
 polyhyramnios  mother older than 35 years
 oligohydramnios
 PROM
 fetal hydrops
Intrapartum factors

•Emergency cesarean section

•Assisted delivery
•Breech or other abnormal presentation
•Premature labour
•Chorioamnionitis
•Prolonged ROM more than 18 hours
•Prolonged labor more than 24 hours
•Macrosomnia
•Use of general anasthesia
•Narcotics to mother within hours of delivery
•Meconium stained amniotic fluid
•Prolapsed cord
•Abruptio placentae
•Placenta previa
•Significant intrapartum bleeding
Neonatal Resuscitation
Program, jointly developed
By American Academy of
Pediatrics AAP and American
Heart Association AHA
Factors that lead to increase heat losses in newborn

 Large surface area

 Transdermal water loss
 Limited capacity to change body position
 Incapable of effective shivering
 Environmental temprature
 Using unheated nonhuumidified oxygen sources during resscitation
 The infant should be positioned as
To open the airway
 A bulb syringe should be used for
Initial suctioning
 Suctioning with a catheter should be
Limited to patients with thick mucous
aspiration
Slapping the sole of the feet or rubbing the
Back can be effective
Infants who do not meet the criteria for routine care
Or have difficulties with respiratory effort, tone or color
May need further intervention
Positive pressure ventilation
 Intubation
 Suctioning
 Medications
 Prolonged assisted
Ventilation
 Candidates
 Maneuver
 3:1
 When to stop it
Medications
Pre-rescucitation Preparation

Personnel

Equipment Skills
 Preheat Warmer
Warm Towels or Blankets
Bulb syringe
10F or 12F suction catheter attached to wall
Clear Airway

Auscultate
suction set at 80-100 mm Hg
Meconium Aspirator
Stethoscope
Equipment
Method to give free-flow oxygen (mask, tubing,
flow-inflating bag or T-piece)
Gases flowing just prior to birth, 5 – 10 L/min Quick
Oxygenate Blender set per protocol
Pulse oximeter probe (detached from oximeter until
needed)
Pulse oximeter
Checklist
Positive-pressure ventilation (PPV) device(s)
present with term and preterm masks
Ventilate PPV device(s) functioning
Connected to air/oxygen source (blender)
8F feeding tube and 20-mL syringe
Larynscope
Size 0 and Size 1 (and size 00, optional) blades
with bright light
Intubate Endotracheal tubes, sizes 2.5, 3.0, 3.5, 4.0
Stylets
End tidal CO2 detector
Laryngeal mask airway (size 1) and 5-mL syringe
Access to 1:10,000 epinephrine and normal saline
Supplies for administering meds and placing
Medicate emergency umbilical venous catheter
Documentation supplies

Plastic bag or plastic wrap

Thermoregulate Chemically activated warming pad
Transport incubator ready
Other
 Senario #1

A baby just born

Term?.........Yes
Breathing or crying?….Yes
Good tone?.....yes
 Senario #2
A baby just born:
Term?.........Yes
Breathing or crying?….Yes
Good tone?.....Yes
*Cyanosed
 Senario #3

A baby just born:

Term?.........Yes
Breathing or crying?…NO
Special Complications
Failure of PPV

MR SOPA

M: Mask adjustment.
R: Reposition airway.
S: Suction mouth and nose.
O: Open mouth.
P: Pressure increase.
A: Airway alternative.
Airways Blockage
• Coanal atresia

• Robin Syndrom
Impaired Lung Function
• Pneumothorax

• Congenital
• Diaphragmatic
• hernia
If remains cyanotic O2 100%

If remains bradycardic ???

Problems in prematurity:
1) Skin
2)Respiratory
3)Brain
4)Muscles
5)Tissues
Prematurity
Multiple Pregnancy
 Contraversies
1) Hypothermia.
2) Artificial Surfactant.
3) Suction for meconium aspiration
4) Room air versus O2 100%