RESUSITASI NEONATUS

Irma Amalia

Berlaku untuk• Bayi baru lahir: masa transisi intrauterin dan

ekstra uterin • Telah mengalami transisi masa lahir dan

membutuhkan resusitasi pada minggu pertama kehidupan (initial hospitalization)

Neonatal Resuscitation Equipment

1.Suction Equipment– Bulb Syringe/mechanical suction and tubing– Suction catheter

2. Bag and mask equipment3. Intubation equipment4. Pulse oxymeter5. Medications :

– Epinephrine 1/10.000– Isotonic crystaloid– Dextrose 40 %– Normal saline– Umbilical Vessel catetherization supplies

5. Tambahan Gloves, radiant warmer, linens, stethoscope, oropharyngeal airway

BULB SYRINGE

APGAR Score

ScoreSign 0 1 2

Heart Rate Absent < 100/ m ≥ 100/ mRespiratons - Slow, irregular Good, cryingMuscle tone Limp Some flexion Active motion

Reflex irritability

No response Grimace Cough, sneeze,cry

Colour Blue or pale Pink body, blue

extremitas

Completely pink

- Assigned at 1 and 5 minute after birth- If < 7 every 5 minute – 20 minute

BAYI BARU LAHIR

• Bernafas 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 resusitasi

Langkah awal/ Initial step stabilisasi HAPE BEKAS

SATU SAJA

• Term 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 minute

• RESPIRATIONS: apnea, gasping, or labored or unlabored breathing

• HEART RATE less than 100/min

POSITIVE PRESSURE VENTILATIONIndication: 1. Apnea or gasping breathing2. Heart rate < 100 bpm3. Persistent 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 ↓

Appropriate PPV is followed by :

- Increase of heart rate- Improved in color- Spontaneous breathing

The most sensitive indicator of a successful response to each step is an increase in heart rate

• Setelah PPV, penilaian ditambah saturasi oksigen heart rate, respirations, and oxygen saturation

• A pulse oximeter + provide a continuous assessment - Lama: 1-2 mnt

Chest Compressions• Two thumb tech. LEBIH EFEKTIF• Indikasi: HR < 60/min padahal ventilasi sudah adekuat• LOKASI: sepertiga bawah sternum• KEDALAMAN: sepertiga diameter anterior posterior• 3:1 = 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.

Epinephrine

• DOSIS 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

Endotracheal 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.

Volume Expansion Volume expansion may be considered when blood loss is

known or suspected (pale skin, poor perfusion, weak pulse) and the infant’s 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

Postresuscitation Care

Cegah hipoglikemia• Hipoglikemia brain injuryCegah Hypothermia

Discontinuing Resuscitative Efforts• An 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

DISCONTINUATION 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.

Referensi

• 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 13: Neonatal Resuscitation

• Special Report—Neonatal Resuscitation: 2010 American Heart Association Guidelines

for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care