RESUSCITATION OF THE

NEWBORN BABY

Why we need to resuscitate:

pH 7.30 pH 7.00 pH 6.80

How often do we use our resuscitation skills?

PREPARING FOR BIRTH

Wash your hands

Draught free, warm room - temperature >250C Clean, dry and warm delivery surface Radiant heater Two clean, warm towels/clothes A folded piece of cloth Self inflating bag - newborn size Infant masks in two sizes - normal and small newborn Suction device Oxygen (if available) Clock

Check if all equipments are in working order

ASSESSMENT AT BIRTH

Deliver the baby on to mother’s abdomenNote and call out time of birthThoroughly dry the baby

Use a warm towel Discard wet towel after drying Wrap the baby in another warm cloth

Keep the baby warm

Assess breathing while drying

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CARE OF THE BABY AT BIRTH

Assess breathing:

H-

Assessment Decision

Baby is crying No need for resuscitation or suctioning; Start skin-to-skin contact and breastfeeding

Baby is not crying, but breathing at 30 to 60 times per minute

No need for resuscitation or suctioning

Baby is gasping Start resuscitation immediately

Baby is not breathing Start resuscitation immediately

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Newborn Resuscitation Algorithm.

Kattwinkel J et al. Pediatrics 2010;126:e1400-e1413

©2010 by American Academy of Pediatrics

Dry the baby immediately after

birth

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Immediate skin-to-skin Contact &

Breastfeeding(routine care)

Steps of resuscitation

If the baby is not breathing or gasping

◦ Call for help!◦ Cut cord quickly, transfer to a firm, warm surface

[under a radiant heater]◦ Inform the mother that baby has difficulty breathing

and you will help the baby to breathe◦ Start newborn resuscitation

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Bag, Mask, & Oxygen

Suction Equipment

Laryngoscope and ETT Tube

Warmer & Blankets

Position

Steps of resuscitation

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Position, clear airways (if needed)

Steps of resuscitation

Suction: Do not exceed duration of 20 sec

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Dry, stimulate, reposition

Steps of resuscitation

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Dry, stimulate, reposition

Steps of resuscitation

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Selecting Bag & Mask equipment• Size of bag: 240-750 ml• Oxygen capability: Oxygen

source, reservoir• Safety feature: Pop off valve,

pressure gauge (optional)

Ventilate (if still not breathing)

Steps of resuscitation

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Use the CORRECT size face mask that covers:

The noseThe mouthThe tip of the chin but not the eyes

Ventilate

Steps of resuscitation

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Fitting a face mask:

• A face mask that is too LARGE– Covers the eyes– Extends over the tip of the chin

• A face mask that is too SMALL– Does not cover the nose– Does not cover the mouth effectively

Steps of resuscitation

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Squeeze bag with 2 fingers or whole hand, 2-3 times

Observe for rise of chest IF CHEST IS NOT RISING:

◦ Check seal◦ Reposition the head◦ Squeeze harder

Once good seal and chest rising, ventilate at 40 squeezes per minute

Observe chest rise Check heart rate after 30 secondsCheck heart rate after 30 seconds

Steps of resuscitation

Ventilate

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If baby is crying;If breathing >30/min, andNO chest in-drawing: ◦ If the skin between the ribs

is ‘sucked’ inwards and the ribs are prominent, the baby has chest ‘in-drawing’

Steps of resuscitation

When to stop ventilating?

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Put the baby in skin-to-skin contact on mother’s chest

Monitor every 15 minutes for breathing and warmth

Tell the mother the baby will probably be wellEncourage the mother to start breastfeeding as

soon as possibleNEVER leave the baby alone

Steps of resuscitation

After stopping ventilation

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If the baby –is breathing at a rate of <30/min, –is gasping–has severe chest in-drawing

• Arrange for immediate referral

Steps of resuscitation

When to continue ventilating?

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No need for intrapartum suction

Birth: assess

HR, breathing and tone

Vigorous: HR>100

good breathing

Good tone

Nonvigorous: any parameter abnormal

Initial steps Tracheal suction

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MECONIUM STAINED AMNIOTIC FLUID

• Be gentle • Use small size resuscitation bag and give small

tidal volumes to move chest• Avoid 100% oxygen , use blenders and oxygen

saturation monitors• Avoid rapid fluid bolus • May need intubation, chest compression,

medications

Steps of resuscitation

Special considerations for preterm

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Post resuscitation management

Principles

1. Keeping normal temperature2. Maintaining oxygenation3. Maintaining physiological milieu- fluids ,

glucose4. Maintaining perfusion5. Treating seizures6. Monitoring organ function

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Care after resuscitation

• Place baby in skin-to-skin contact with mother• Keep the baby warm• Monitor every 15 minutes• Start breastfeeding as soon as possible• Discuss what has happened with the parents -

be positive!• Do not separate the mother and baby unless

the baby has difficult breathing

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