1. initiation and maintenance of respirations 2. establishment of extrauterine circulation 3. control of body temperature 4. intake of adequate nourishment 5.

Establishment of waste elimination 6. Prevention of infection 7. Establishment of an infant-parent relationship 8. Developmental Care, or care that balances physiologic needs and stimulation for best development

Position the baby on its' back with the head looking straight up. This will usually provide for good airflow.

Suction first from the mouth

Then from the nose

Ineffective breathing Circulatory shunts will fail to close Ineffective pump action in the heart Newborn struggles to breathe and circulate blood and become hypoglycemic RESUSCITATION

RESUSCITATION Establish and maintain an airway Expand the lungs Initiate and maintain effective ventilation

AIRWAY

pass suction

Size 0 or 1

LUNG EXPANSION

Pulse oximeter- to monitor oxygen level

DRUGS USED IN RESUSCITATION

NALAXONE (Narcan) - used if depression of respiration is due to morphine (demerol)

Atropine - reduces bronchial secretions Calcium Chloride-inc heart contractility Dopamine-inc systemic blood perfusion Epinephrine-initiates cardiac contractions Lidocaine-counteracts ventricular arrythmias Sodium Bicarbonate-corrects metabolic
acidosis

Surfactant restores naturally occuring

surfactant to improve lung compliance

Nitric Oxide-vascular dilator Liquid ventilation (liquid fluorocarbon)-anti-inflammatory, reduces

oxygen toxicity and infection

Ineffective respiratory function ->ineffective cardiac function If CR is not audible or below 80 bpm -> start closed chest massage

Hold infant with fingers supporting the back Depress sternum (1-2cm) with two fingers Continue lung ventilation Lung ventilation should be interspersed with cardiac massage at a ratio of 1:5 If heart sounds not resumed above 80bpm after 30 secs, 0.1-0.3mL/kg epinephrine is given sprayed into ET tube

Maintaining fluid and electrolyte balance

Ringers Lactate or 5% dextrose in water
To maintain fluid and electrolyte levels
Rate should be maintained carefully High fluid intake can lead to patent ductus arteriosus or heart failure Signs of hypovolemia:
increased:heart rate Decreased: arterial blood pressure, central venous pressure(pressure of blood w/n the rt atrium), tissue perfusion

To increase blood volume in case of hypovolemia

Dehydrated if U.O < 2mL/kg/h or Urine specific gravity > 1.015 to 1.020 o If with hypotension without hypovolemia > DOPAMINE may be given to inc BP

Monitor urine output and urine specific gravity

3. control of body temperature

neutral temp environment should be maintained To prevent newborn from becoming chilled:
Wipe the infant dry Cover the head with a cap Place him immediately under a prewarmed radiant warmer or a warmed incubator or skin to skin against the mother Temp should be kept regulated to maintain axillary temp of 36.5C (97.8)

KANGAROO CARE

If infant experienced asphyxia at birth -> IVF is administered If RR remains rapid and Necrotizing enterocolitis has been ruled out -> gavage feeding Breastfeed if possible
If not use expressed breastmilk for gavage feeding Maintain oral stimulation by giving pacifier

Immature infants may void and pass stool later than the term infant
BP may not be adequate to supply the kidney Meconium has not yet reached the end of the intestine by birth

Document any voidings during resuscitation > proof that hypotension is improving and kidneys are being perfused

Infection> increases metabolic demands

stresses the immature immune system To prevent: Skin care Good handwashing technique and standard precaution by the personnel
>

Prenatal: offer a tour of a NICU Postpartum:

keep parents informed of what is happening during resuscitation at birth Allow and urge them to visit NICU

Anticipatory guidance Support before and after discharge

Assess the level of knowledge about childs condition and development Give education and referral to a home care agency Evaluate safety of their home Instruct how to properly transport a preterm infant in a car
Blanket and head support are necessary (small infant does not fit securely in a standard infant car seat)