RESUSITASI NEONATUSIrma Amalia1Berlaku untukBayi baru lahir: masa transisi intrauterin dan ekstra uterin Telah mengalami transisi masa lahir dan membutuhkan resusitasi pada minggu pertama kehidupan (initial hospitalization)2Neonatal Resuscitation Equipment1.Suction EquipmentBulb Syringe/mechanical suction and tubingSuction catheter2. Bag and mask equipment3. Intubation equipment4. Pulse oxymeter5. Medications :Epinephrine 1/10.000Isotonic crystaloidDextrose 40 %Normal salineUmbilical Vessel catetherization supplies5. Tambahan Gloves, radiant warmer, linens, stethoscope, oropharyngeal airway
4APGAR ScoreScoreSign012Heart RateAbsent< 100/ m 100/ mRespiratons-Slow, irregularGood, cryingMuscle toneLimpSome flexionActive motionReflex irritabilityNo responseGrimaceCough, sneeze,cryColourBlue or palePink body, blue extremitasCompletely pink Assigned at 1 and 5 minute after birth If < 7 every 5 minute 20 minute5BAYI BARU LAHIRBernafas dan menangis delayed cord clamping ( sekitar 30 detik) DCC is associated with less intraventricular hemorrhage (IVH) of any grade, higher blood pressure and blood volume, less need for transfusion after birth, and less necrotizing enterocolitis.Tidak bernafas atau tidak menangis cord clamped resusitasi6
Langkah awal/ Initial step stabilisasi HAPE BEKASSATU SAJA8Term gestation?Crying or breathing? Good muscle tone?
THREE yes, not need resuscitation keringkan, placed skin-to-skin with the mother, and covered with dry linen to maintain temperature Observation of breathing, activity, and color should be ongoing.
Suction dilakukan hanya jika sekret kental dan/ atau menghalangi jalan nafas
Golden minuteRESPIRATIONS: apnea, gasping, or labored or unlabored breathingHEART RATE less than 100/min10
POSITIVE PRESSURE VENTILATIONIndication: Apnea or gasping breathingHeart rate < 100 bpmPersistent central cyanosis despite FI O2 100%
Use : 1. Flow inflating bag 2. Self inflating bag
Rate : 40 60 breath per minute satu lepas lepas
Pressure : 30 40 cm H2O and then
11Appropriate PPV is followed by :Increase of heart rateImproved in colorSpontaneous breathing
The most sensitive indicator of a successful response to each step is an increase in heart rate
12Setelah PPV, penilaian ditambah saturasi oksigen heart rate, respirations, and oxygen saturation
A pulse oximeter + provide a continuous assessment - Lama: 1-2 mnt
14Chest CompressionsTwo thumb tech. LEBIH EFEKTIFIndikasi: HR < 60/min padahal ventilasi sudah adekuatLOKASI: sepertiga bawah sternumKEDALAMAN:sepertiga diameter anterior posterior3:1 = compressions : ventilation 90 compressions and 30 breaths = 120 events per minute to maximize ventilation at an achievable. Thus, each event will be allotted approximately a half of a second, with exhalation occurring during the first compression after each ventilation. A 3:1 compression-to-ventilation ratio is used for neonatal resuscitation where compromise of gas exchange is nearly always the primary cause of cardiovascular collapse, but rescuers may consider using higher ratios (eg, 15:2) if the arrest is believed to be of cardiac origin.15EpinephrineDOSIS 0.01 to 0.03 mg/kg of 1:10 000 epinephrine INTRAVENA (Umbilical vein)
ETT 0.05 to 0.1 mg/kg
Repeat every 3 5 minutes
16Endotracheal IntubationIndications :1. to improve ventilation in bag and mask ventilation in effective2. To coordinate ventilation and chest compression3. To administration medication such as epinephrine4. When prolonged ventilation is needed5. Administer surfactant6. When congenital diaphragmatic hernia is suspected.
17Volume ExpansionVolume expansion may be considered when blood loss is known or suspected (pale skin, poor perfusion, weak pulse) and the infants heart rate has not responded adequately to other resuscitative measures. An isotonic crystalloid solution or blood may be considered for volume expansion in the delivery room. The recommended dose is 10 mL/kg, which may need to be repeated. When resuscitating premature infants, it is reasonable to avoid giving volume expanders rapidly, because rapid infusions of large volumes have been associated with IVH
18Postresuscitation CareCegah hipoglikemiaHipoglikemia brain injuryCegah Hypothermia
19Discontinuing Resuscitative EffortsAn Apgar score of 0 at 10 minutes is a strong predictor of mortality and morbidity in late preterm and term infants. We suggest that, in infants with an Apgar score of 0 after 10 minutes of resuscitation, if the heart rate remains undetectable, it may be reasonable to stop assisted ventilation; however, the decision to continue or discontinue resuscitative efforts must be individualized. Variables to be considered may include whether the resuscitation was considered optimal; availability of advanced neonatal care, such as therapeutic hypothermia; specific circumstances before delivery (eg, known timing of the insult); and wishes expressed by the family
20DISCONTINUATION OF RESUCITATION 2010
In a newly born baby with no detectable heart rate, it is appropriate to consider stopping resuscitation if the heart rate remains undetectable for 10 minutes (Class IIb, LOE C.
21Referensi 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 13: Neonatal ResuscitationSpecial ReportNeonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care