RESUSCITATION OF NEW BORN

For extra uterine survival the newborn has to replace the fluid in his lungs by air. These can be achieved by two methods 1. Squeezing of the fetal chest wall by the birth canal.(1/3 of fluid) 2. Absorption into perialveolar lymphatic and blood vessels take place (2/3 fluid). This will occur when the baby takes few breaths.

EQUIPMENTS NEEDED FOR RESUSCITATION 1. Radiant warmer. 2. Suction apparatus. 3. Suction catheter (8 to 10F). 4. Ampu bag. 5. Face mask. 6. Oxygen reservoir. 7. Oxygen catheter. 8. Shoulder roll (1 inch thickness). 9. Laryngoscope. 10. Stethoscope. 11. Endo tracheal tube. 12. Medications i. ii. iii. iv. Adrenalin or epinephrine (1:10,000dilution). Volume expander (Ringer lactate or Normal saline). Sodium bicarbonate. Nalexone.

TABC OF RESUSCITATION

Airway

Breathing

Temperature

Circulation

TABC
INITIAL STEPS OF RESUSCITATION 1. Placing the baby on the preheated radiant warmer. If warmer is not available, room heater or a bulb of 200W can be used. 2. Drying the babys whole body and head quickly and removing the wet linen immediately. 3. Proper positioning slight extension of neck with the help of shoulder roll (1 inch thick) placed under the shoulder. This position is maintaining throughout the procedure. 4. Suctioning of the mouth should be done first then the nose; otherwise there is a chance of aspiration of secretions from mouth. Suction pressure to be kept around 80mm of Hg. 5. Assessing the baby for breathing, if not breathing 6. Tactile stimulation. Stimulate the sole of the baby (apply firm flips on the sole or sharp slaps). Gently rub the infants back. 7. If the baby is not breathing normally means starting bag and mask ventilation. 8. If the baby breaths normally, then checking the heart rate. Checking only the 6sec heart rate.
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 More than 10 mean normal. Less than 10 mean need further resuscitation. 9. If the heart rate is normal, then checking the colour of the baby, Pink or peripheral cyanosis present means normal. Central cyanosis present means providing free flow oxygen. Placing catheter inch away from the nostrils (80% oxygen). If the baby found pink means increasing distance from to 1 inch (60% oxygen) then 2 inch (40% oxygen) and removing the catheter. Not remove the catheter abruptly. On the other way we can provide oxygen with the oxygen mask. First mask is tight on the face which provides 60 to 80% oxygen. If the baby found pink then loosing the mask which provide 40 to 60% oxygen then removing the mask.

BAG AND MASK VENTILATION Indication 1. Baby is not breathing. 2. Baby is breathing but heart rate is less than 100bpm. Steps 1. Proper positioning slight extension of neck with the help of shoulder roll (1 inch thick) placed under the shoulder. 2. Placement of the mask it must cover chin, mouth and nostrils and must not cover the eyes. 3. Gently press the bag at a rate of 40-60/minutes. ie one two squeeze one two squeeze one two squeeze 4. After 20-30sec, the baby should be evaluated.

CHEST COMPRESSION Chest compression or external cardiac massage must always be performed along with ventilation in 3:1 ratio (3- chest compression and 1- ventilation) so two person is needed. It is done by thumb technique or two finger technique.

Thumb technique and two finger technique

Steps 1. Proper positioning. 2. Identify the area, where pressure is applied. Lower third of sternum. 3. Place the fingers on fixed position should not be withdraw during the course of chest compression. 4. Start to give chest compression at a rate of 90/minute. And it has to be altered with bag and mask ventilation at 3:1 ratio (3- chest compression and 1- ventilation). 5. Each compression chest goes down to inches. 6. After 30sec, the baby should be evaluated; Heart rate is greater than 80bpm- stop chest compression and continue bag and mask ventilation till the heart rate reaches more than 100bpm.

ENDOTRACHEAL INTUBATION Only a small number of neonates required ET intubation. Indications 1. Prolonged PPV (Positive Pressure Ventilation). 2. Bag and mask ventilation is ineffective. 3. Tracheal suction is needed. 4. Diaphragmatic hernia is suspected.

MEDICATIONS 1. Epinephrine or Adrenalin (1:10,000 dilutions). Indication Dose Route IV or ET 0.1 to 0.3ml/kg body wt. The heart rate stays below 60bpm despite effective ventilation and chest compressions for at least 30 seconds. The heart rate is zero.

Action Increase the force and rate of heart beat.

2. Volume expander (RL or NS) Indication Signs of hypovolemia.

Dose Route IV over 5 to 10min. 10ml/kg body wt.

3. Sodium bicarbonate Indication Dose Route Slow IV 2meq/kg body wt. Severe asphyxia

4. Nalexone Indication Dose Route Give rapidly IV or ET. 0.1ml/kg body wt. Respiratory depression secondary to morphine or pethidine 4 hours prior to delivery.