Neonatal Resuscitation

1
Neonatal Resuscitation

• Joseph Gilhooly, MD
• Doernbecher Childrens Hospital

2
NRP 2001
3
Resuscitation Algorithm 2001
4
Why we need to resuscitate
pH 7.30
pH 7.00
pH 6.80
5
How often do we use our resuscitation skills?
6
Suction Equipment
Warmer Blankets
Bag, Mask, Oxygen
Laryngoscope and ETT Tube
7
Universal Precautions
8
Assessment Then

• Appearance
• Pulse
• Grimace
• Activity
• Respirations

9
Assessment Now
Physiologic Parameters (Apgars best)
Questions to ask yourself

• Clear of Meconium?
• Breathing or Crying?
• Good Muscle tone?
• Color Pink?
• Term Gestation?

• Breathing
• Heart Rate
• Color

10
Initial Management For all deliveries

• Provide warmth
• Position and Clear Airway
• Dry
• Give Oxygen (as necessary)

11
Providing Warmth The cycle of hypothermia
Acidosis
Pulmonary Vasoconstriction
Anaerobic metabolism
Pulmonary Hypertension
Tissue hypoxia
Right to left shunting
Hypoxemia
12
Positioning Sniffing
13
The Trusty Bulb Syringe
14
Clear of Meconium?
15
Color pink?
16
Pulse Oximetry Resuscitation monitor

• Not affected by acrocyanosis
• Be patient and get a reading
• If baby in shock, get central IV access

17
Breathing or Crying?

• Indications for PPV
• Apnea or gasping
• Heart rate lt100 even if breathing
• Persistent central cyanosis (saturation lt90)
  despite 100 free-flow oxygen

18
Self-Inflating Bag
O2 Reservoir
Pressure manometer attaches
PEEP valve port
200-750ml Bag size
19
Neopuff

• CPAP
• Pressure limited ventilation with PEEP
• Blended oxygen
• Eliminates variability associated with bag
  ventilation

20
Masks
Smallest sizes are for preterm infants
21

• Make sure the airway is clear
• Lift the babys jaw into the mask
• Keep the mouth slightly open

Rate 40-60
22
Indications for Intubation

• Meconium and baby is not vigorous
• PPV by bag-mask does not result in good chest
  rise
• PPV needed beyond a few minutes
• Chest compressions necessary
• Route to administer epinephrine
• Special indications Prematurity, CDH

23
Miller 0
Miller 1
24
gt2000 gm
3.5
3.0
1000-2000 gm
2.5
lt1000 gm
Stylet
25
Intubation Technique
26
Lip reference mark (6 weight in kilos) cm

9-10 cm at the lip for this term infant
27
Indications for Compressions

• Heart rate lt60 bpm after 30sec of PPV

• Coordinate with ventilation
• 4 events in 2 seconds
• 90 compressions and 30 breaths per minute

One and Two and Three and Breathe
2 seconds
28
Compressions
2 thumb technique preferred
29
Medications Epinephrine

• Indication Heart rate lt60 after 30 sec of
  coordinated ventilation and compressions
• 110,000 (0.1mg/ml)
• Route ETT or IV
• 0.1-0.3 ml/kg
• 1ml Term
• 0.5ml Preterm
• 0.25ml Extreme preterm

30
Extended Algorithm

• Endotracheal Intubation if not already
  accomplished
• Establish IV access with UVC
• Stat CXR
• Discontinue efforts if no heart rate after 15
  minutes

31
IV Access Low UVC
32
Volume

• Indication No response to resuscitation and
  evidence of blood loss
• Normal Saline
• Ringers or Blood as alternatives
• 10 ml/kg, may repeat
• Route IV (Umbilical vein)

33
Sodium Bicarbonate

• Indication Documented or assumed metabolic
  acidosis
• Concentration 4.2 NaHCO3 (0.5meq/ml)
• Dose 2meq/kg
• Route IV (Umbilical vein)

34
Naloxone (Narcan)

• Indication Severe respiratory depression after
  PPV has restored a normal HR and color and
• History of maternal narcotic administration
  within the past 4 hours
• Dose 0.1mg/kg of 1mg/ml solution
• Route ETT, IV, IM, SQ

35
Hypoglycemia

• Blood Glucose lt45-60
• 5cc/k D10W
• Route IV