Neonatal Resuscitation

Course overview

Objectives Describe apnea in the neonate and treatment options Explain the pathophysiology of common disorders that lead to neonatal resuscitation Describe specific circumstances that can be encountered with neonatal resuscitation Content Information Covered 1 Introduction Newborn Neonate A recently born infant usually considered the first few hours of life Considered the first 28 days of life General pathophysiology assessment and management Epidemiology Incidence Approximately 6 percent of deliveries require life support Incidence of complications increases as birth weight decreases Morbidity and mortality Neonatal mortality risk can be determined via graphs based on birth weight and gestational age Resuscitation is required for about 80 percent of the 30000 babies who weigh less than 1500 grams at birth Risk factors Antepartum factors Multiple gestation Inadequate prenatal care Mothers age less than 16 or greater than 35 History of perinatal morbidity or mortality Post term gestation Drugs or medications Toxemia hypertension diabetes Perinatal infections Known fetal malformations high risk OB patient Intrapartum factors Premature labor Meconium stained amniotic fluid Rupture of membranes greater than 18 hours prior to delivery Use of narcotics within four hours of delivery Abnormal presentation Prolonged labor or precipitous delivery Prolapsed cord Bleeding Treatment strategies Preparation of resuscitation equipment Determine appropriate destination Pathophysiology Transition from fetal to neonatal circulation Respiratory system must suddenly initiate and maintain oxygenation Infants are very sensitive to hypoxia Permanent brain damage will occur with hypoxemia Apnea in newborns Primary Secondary Congenital anomalies Diaphragmatic hernia Choanal atresia Pierre Robin syndrome Cleft lip Other craniofacial defects Spina bifida Exposed abdominal contents Intact omphalocele Non intact omphalocele Other common conditions Assessment of the newborn Time of delivery Normal or abnormal vital signs Airway and ventilation Respiratory rate Respiratory effort Circulation Heart rate Color cyanosis Normal Central versus peripheral Mucosal membranes End organ perfusion Capillary refill Compare strength of central pulses versus peripheral APGAR Appearance skin color Completely pink 2 Body pink extremities blue 1 Blue pale 0 Pulse rate Above 100 2 Below 100 1 Absent 0 Grimace irritability Cries 2 Grimaces 1 No response 0 Activity muscle tone Active motion 2 Some flexion of extremities 1 Limp 0 Respiratory effort Strong cry 2 Slow and irregular 1 Absent 0 Treatment Prior to delivery prepare environment and equipment During delivery suction mouth and nose as head delivers After delivery Airway and ventilation Drying head face body Warming appropriate techniques minimize heat loss via head Position Suction Equipment Bulb suction mouth first then nares nasal suctioning is a stimulus to breathe Suction catheters Meconium aspirator Stimulation Flicking soles of feet Stroking back Blow by oxygen Never withhold oxygen Oxygen should be warmed Use when newborn is cyanotic heart rate greater than 100 adequate respiratory rate and effort Five liters per minute maximum Complications due to hypothermia Direct rather than tangential flow on face Appropriate techniques Oral airways rarely used for neonates Necessary to keep mouth open for ventilation Bilateral choanal atresia Pierre Robin syndrome Macroglossia Craniofacial defects affecting airway Bag valve mask Mask characteristics Appropriate size Minimize dead space Bag characteristics Pop off valve should be disabled Risk of pneumothorax with excessive pressures Initial breath may require high pressures Use when Apneic Inadequate respiratory rate or effort Heart rate less than 100 Technique Initial ventilations require higher pressure to expand lungs Rate Intubation Indications Prolonged positive pressure ventilation Bag and mask ventilations ineffective Tracheal