Resuscitation of the newborn baby

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Resuscitation of the newborn baby
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Learning objectives

• To assess a newborn baby at birth
• To perform basic resuscitation of a newborn baby
  using standard equipment
• Resuscitation in special situations meconium
  stained liquor and preterm birth
• To learn principles of aftercare for a baby who
  requires resuscitation at birth

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Resuscitation Key words

• Anticipation
• Preparation
• Help
• Record

• Fast
• Gentle
• Warmth
• Hygiene
• Mother

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Preparing for birth

• Wash your hands
• Draught free, warm room - temperature gt250C
• Clean, dry and warm delivery surface
• Radiant heater
• Two clean, warm towels/clothes
• A folded piece of cloth
• Self inflating bag - newborn size
• Infant masks in two sizes - normal and small
  newborn
• Suction device
• Oxygen (if available)
• Clock

Check if all equipments are in working order
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Assessment at birth

• Deliver the baby on to mothers abdomen
• Note and call out time of birth
• Thoroughly dry the baby
• Use a warm towel
• Discard wet towel after drying
• Wrap the baby in another warm cloth
• Keep the baby warm
• Assess breathing while drying

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Care of the baby at birth

• Assess breathing

Assessment Decision
Baby is crying No need for resuscitation or suctioning Start? skin-to-skin contact and breastfeeding
Baby is not crying, but breathing at 30 to 60 times per minute No need for resuscitation or suctioning
Baby is gasping Start resuscitation immediately
Baby is not breathing Start resuscitation immediately
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Scenario 1

• A mother arrived at your maternity hospital and
  delivered a baby girl as soon as she reached the
  labor ward. The placenta followed the baby and
  mother was not bleeding.
• The baby was pale. He was breathing and heart
  rate was 120/min.
• What is the Action?

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Dry the baby immediately after birth
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• Immediate
• skin-to-skin
• Contact
• Breastfeeding
• (routine care)

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Message 1

• ONLY Routine care is required for a baby who is
  crying or breathing normally
• Even routine suctioning is not required for these
  normal babies

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Scenario 2

• A baby girl is born at your clinic after second
  stage of 60 minutes. The umbilical cord is short.
• You see that the skin is pale .She is not
  breathing. Heart rate is over 100/min.
• What is the Action?

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Steps of resuscitation

• If the baby is not breathing or gasping
• Call for help!
• Cut cord quickly, transfer to a firm, warm
  surface under a radiant heater
• Inform the mother that baby has difficulty
  breathing and you will help the baby to breathe
• Start newborn resuscitation

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Position, clear airways
Steps of resuscitation
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Position, clear airways
Steps of resuscitation
v
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Steps of resuscitation
Position, clear airways (if needed)
Suction Do not exceed duration of 20 sec
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Steps of resuscitation
Dry, stimulate, reposition
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Steps of resuscitation
Dry, stimulate, reposition
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Steps of resuscitation
Dry, stimulate, reposition
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Steps of resuscitation
Ventilate (if still not breathing)

• Selecting Bag Mask equipment
• Size of bag 240-750 ml
• Oxygen capability Oxygen source, reservoir
• Safety feature Pop off valve, pressure gauge
  (optional)

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Steps of resuscitation
Ventilate

• Use the CORRECT size face mask that covers
• The nose
• The mouth
• The tip of the chin
• but not the eyes

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Steps of resuscitation

• Fitting a face mask
• A face mask that is too LARGE
• Covers the eyes
• Extends over the tip of the chin
• A face mask that is too SMALL
• Does not cover the nose
• Does not cover the mouth effectively

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Steps of resuscitation
Ventilate

• Squeeze bag with 2 fingers or whole hand, 2-3
  times
• Observe for rise of chest
• IF CHEST IS NOT RISING
• Check seal
• Reposition the head
• Squeeze harder
• Once good seal and chest rising, ventilate at 40
  squeezes per minute
• Observe chest rise
• Check heart rate after 30 seconds

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Message 2

• Bag and mask ventilation is required for a baby
  NOT BREATHING or GASPING

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Steps of resuscitation
When to stop ventilating?

• If baby is crying
• If breathing gt30/min, and
• NO chest in-drawing
• If the skin between the ribs is sucked inwards
  and the ribs are prominent, the baby has chest
  in-drawing

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Steps of resuscitation
After stopping ventilation

• Put the baby in skin-to-skin contact on mothers
  chest
• Monitor every 15 minutes for breathing and warmth
• Tell the mother the baby will probably be well
• Encourage the mother to start breastfeeding as
  soon as possible
• NEVER leave the baby alone

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Steps of resuscitation
When to continue ventilating?

• If the baby
• is breathing at a rate of lt30/min,
• is gasping
• has severe chest in-drawing
• Arrange for immediate referral

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Steps of resuscitation
Referral

• Explain to the mother what happened, that her
  baby needs help with breathing
• Ventilate during the referral
• Record the event on a referral form and labour
  record
• If the baby is NOT breathing even after 20
  minutes, STOP ventilating

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Scenario 3

• Baby girl born at 38 weeks following thick
  meconium stained amniotic fluid is noted to be
  limp and not breathing .
• The baby is blue. She was not breathing and heart
  rate was 80/min.
• What is the Action?

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Message 3

• Meconium stained depressed baby needs
• endotracheal suction prior to BMV
• Routine suction of oro-pharynx is not recommended
  before delivery of shoulder

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Scenario 4

• Mother admitted in maternity unit delivered a
  baby boy at 32 week gestation on bed. The baby
  is limp and not breathing.
• The baby is pale. He is not breathing and HR is
  80/min.
• What is the Action?

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Steps of resuscitation
Special considerations for preterm

• Be gentle
• Use small size resuscitation bag and give small
  tidal volumes to move chest
• Avoid 100 oxygen , use blenders and oxygen
  saturation monitors
• Avoid rapid fluid bolus
• May need intubation, chest compression,
  medications
• Keep CPAP back up ready

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Message 4

• Preterm births need special precautions before
  and during resuscitation

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Post resuscitation management

• Principles
• Keeping normal temperature
• Maintaining oxygenation
• Maintaining physiological milieu- fluids ,
  glucose
• Maintaining perfusion
• Treating seizures
• Monitoring organ function

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Care after resuscitation

• Place baby in skin-to-skin contact with mother
• Keep the baby warm
• Monitor every 15 minutes
• Start breastfeeding as soon as possible
• Discuss what has happened with the parents - be
  positive!
• Do not separate the mother and baby unless the
  baby has difficult breathing

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Summary Steps of resuscitation

• 1. Keep the baby warm Place under the radiant
  heater
• 2. Open the airway
• - Position babys head so it is slightly
  extended
• - Suction the mouth and then the nose
• 3. If still not breathing VENTILATE
• 4. If breathing or crying begins STOP
  VENTILATION

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Summary Steps of resuscitation

• 5. If breathing at lt30 breaths per minute or
  there is severe chest in-drawing CONTINUE
  VENTILATION
• 6. If no breathing or gasping after 20 minutes of
  ventilation STOP VENTILATION
• 7. Explain events to the mother and document