1 / 35

Neonatal Resuscitation

Neonatal Resuscitation. Joseph Gilhooly, MD Doernbecher Children’s Hospital. NRP 2001. Resuscitation Algorithm: 2001. Why we need to resuscitate:. pH 7.30. pH 7.00. pH 6.80. How often do we use our resuscitation skills?. Suction Equipment. Warmer & Blankets. Bag, Mask, & Oxygen.

nathan
Download Presentation

Neonatal Resuscitation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Neonatal Resuscitation Joseph Gilhooly, MD Doernbecher Children’s 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 (Apgar’s best) • Breathing • Heart Rate • Color Questions to ask yourself • Clear of Meconium? • Breathing or Crying? • Good Muscle tone? • Color Pink? • Term Gestation?

  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 <100 even if breathing • Persistent central cyanosis (saturation <90%) 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 baby’s 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. >2000 gm 3.5 3.0 1000-2000 gm 2.5 <1000 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. Heart rate <60 bpm after 30sec of PPV Coordinate with ventilation 4 events in 2 seconds 90 compressions and 30 breaths per minute Indications for Compressions One and Two and Three and Breathe 2 seconds

  28. Compressions 2 thumb technique preferred

  29. Medications: Epinephrine • Indication: Heart rate <60 after 30 sec of coordinated ventilation and compressions • 1:10,000 (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 <45-60 • 5cc/k D10W • Route IV

More Related