MEDICAL, HEALTH, PEDIATRICS NEWBORN RESUSCITATION BY DR G GANGADHAR RAO MOB.PHONE NO +91 9493 864912 EMAIL: doctorhyderabad@gmail.com

1. NEW BORN RESUSCITATION &
MECONIUM ASPIRATION
Dr. G GANGADHAR RAO
GUNTUR MEDICAL COLLEGE
FORMER PAEDIATRICIAN YASHODA HOSPITAL SEC.
Department of Pediatrics
COMPOSITE HOSPITAL CRPF HYDERABAD
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3. MECONIUM ASPIRATION
SYNDROME
Mortality and morbidity is 28% to 40% of MAS.
INCIDENCE IS 8.8%, USUALLY POSTMATURE INFANTS,
APGAR SCORE 1- 5 Min. IS LESS THAN 6
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4. What is Meconium?
• In Greek - means "Poppy juice".
• Black Green, Thick sticky odorless and acidic
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5. Contents
• Water 72%-80% • Proteins
• Intestinal secretions • Lipids 8% dry wt.
• Epithelial cells • Bile acids and salts
• Swallowed Amniotic fluid • Enzymes
• Mucopolysacchrides 80% • Blood substances
of dry wt. • Squamous cells and
• Cholesterol and Sterol Vernix caseosa.
precursors
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7. Pathogenesis
• Bile salts are blamed for. Exact cause unknown.
• Inflammatory response by lung tissue.
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8. Introduction
• Cause of Respiratory failure in newborn.
• Inhalation of Meconium causes respiratory distress.
• Degree of severity vary.
• Meconium in Amniotic fluid 10%-20% of total deliveries.
• Mortality and morbidity in 28% to 40%
of MAS.
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9. Incidence
• Amniotic fluid stained in 16.5% (India)
• MAS develop in 18.7%
• MAS 1.44% in all births
• No seasonal variation
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10. Definition
• Meconium below the vocal cords.
• Mild MAS < 40% Oxygen needed for < 48 hrs.
• Moderate MAS > 40% Oxygen needed for > 48 hrs.
• Severe MAS Ventilation > 48 hrs often with
persistent pulmonary hypertension.
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11. Working definition
• Staining of Liquor Umbilical cord. Skin and nail.
• Respiratory distress after 1 hr of birth.
• Radiological features of Aspiration pneumonitis.
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12. Causes in-utero
• Meconium staining rarely
before 38wt
• Levels of motilin
• Maturity of myelination of
• Foetal distress – hypoxia
gut
• Diving reflex
• Lack of strong peristalsis
of gut • Umbilical cord
compression
• Good sphincter tone
• Gut maturation
• „Cap‟ viscous meconium in
rectum • Breech presentation
• Listeriosis in foetus –
foetal diarrhoea
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13. Risk factor
• Maternal hypertension and diabetes mellitus
• Maternal heavy smoking.
• Chronic Respiratory and CVS disease.
• Post term pregnancy.
• Pre eclampsia / Eclampsia.
• Oligohydramnios.
• Poor biophysical profile.
• Foetal distress (Abnormal
Heart Rate)
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14. Mechanism of injury
1. Mechanical Obstruction.
2. Pneumothorax – “Ball Valve”.
3. Pneumonitis
1. Bile salts
2. Bile acids
3. Release of cytokines
4. Pulmonary Vasoconstriction.
5. Surfactant Inactivation.
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15. Pathophysiology
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16. Clinical Features
• Usually full term and post term
• Signs of post maturity.
• Green Yellow staining of nails, skin and umbilical cord.
• Afebrile, Fever or hypothermia if infected.
• Resp. rate > 120/min.
• Subcostal, Intercostal and sternal retraction.
• Use of accessory muscles
• Flaring of nostrils
• Grunt
• Increased Ant. Post diameter
• Apnoea
• Rhonchi and crepitations.
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17. Clinical Features - Contd..
CVS 1. Hypoxic myocardial damage.
2. Hypotension
3. CCF
4. S2 may be single
5. Murmur of tricuspid regurgitation
Abd 1. Distended (Aerophagia)
2. Liver and Spleen displaced.
3. Constipation.
4. Absent bowel sounds in severe cases.
5. Urinary retention.
CNS: 1. Hypoxic ischemic Encephalopathy.
2. Signs of birth asphyxia. RAO G
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19. Complications
• Pneumothorax
• Pneumomediastenum
• Pneumopericardium
• Pneumoperitonium
• Subcutaneous Emphysema
• Broncho pulmonary Dysplasia
• Persistent Pulmonary Hypertension
• Pulmonary damage
• Cerebral damage (Hypoxic)
• Secondary Bacterial Infection
• Renal Failure
• Complication of intubation and ventilation
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21. Diagnosis
• Meconium stained amniotic
fluid (MSAF)
• Presence of meconium in trachea.
• Radiological features.
Always suspect MAS in MSAF.
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22. Investigations
• Hb % normal
• White cell count R
• Thrombocytopenia with PPH
• Disseminated Intravascular coagulation
• PaCO2 Low – Normal - Raised
• Metabolic acidemia
• Culture for sepsis
• Parameters of renal failure
• Urine analysis – Normal except in renal failure
• Color is Greenish brown due to Meconium pigment
• ECG -Normal
• ECHO – Reduced cardiac contractility
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24. Radiology
Use: Determine the extent of intrathoracic
pathology
• Identify areas of atelectasis and air block
syndromes.
• Assure appropriate positioning of endotracheal tube
and umbilical artery catheter.
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25. Radiology - Contd..
• Patchy infiltrates.
• Increased anterioposterior diameter.
• Atelectasis.
• Flattening of diaphragm.
• Retrosternal lucency.
• Small pleural effusions in about 33% cases.
• Pneumothorax and/or pneomediastinum in 25% cases.
• Diffuse chemical pneumonitis
• Cardiomegaly to be detected due to underlying perinatal
asphyxia
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27. Management
• Minimal handling
• Routine care – Thermal environment, hydration, oxygen.
• Suction of oropharynx every 30 min
• Chest Physiotherapy
• Correction of Acidosis
• Monitor BP and Renal functions
• Blood gas monitoring.
• Ventilation IPPV 60-80 / min,
CPPV – unusual.
• IV tolazoline for PPHT
• Antibiotic if infection suspected.
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29. Prevention
• Optimum Antenatal care
• Risk factors for MAS
• Monitoring of foetal heart for
foetal distress
• Foetal scalp blood pH where possible
• Expediate delivery if foetal distress
• Avoid post maturity (more than 42 wt.)
• Presence of two skilled persons in resuscitation for every
delivery in labour room
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31. Prevention contd.
Intrapartum MSAF present:
• Aspirate oropharynx first then nasopharynx after
the birth of head.
• Assess the newborn after birth.
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32. Classification
Vigorous Newborn: Non Vigorous Newborn:
• Strong spontaneous Resp. Airway suction
Effort Direct laryngoscopy and
• Good muscle tone suction
• Heart rate > 100/min
• Monitor for MAS
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40. NEW BORN RESUSCITATION
Intubate
• Suction through Intubation tube.
• Continue tracheal aspiration with meconium
aspiration till “little or no meconium is aspirated or
heart rate indicates resuscitation”.
• Aspirate Gastric meconium
sev asthma.MP G
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50. Do’s
1. Oropharyngeal suction at perineum in all MSAF babies.
2. Intrapartum fetal heart rate monitoring in all MSAF
babies.
3. Anticipate passage of meconium or MAS during birth of
all IUGR babies in the labor room.
4. Skillful resuscitation and assistance are key points in
management.
5. Do intubate neonates born through MSAF who are
depressed (non vigorous babies) at birth irrespective of
consistency of meconium.
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52. Dont’s
• Do not go by the consistency of
meconium in management for intubation.
• Do not apply cricoid pressure,
chest compression or occlude
airway by fingers to prevent initiation
of respiration in MSAF babies.
• Do not ignore the general condition of baby during
intubation.
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53. CH CRPF PHOTOES – (SEE FILE)
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64. Thank you
Dr. G GANGADHAR RAO
STUDENT OF GUNTUR MEDICAL COLLEGE
FORMER PAEDIATRICIAN YASHODA HOSPITAL SEC.
Department of Pediatrics
COMPOSITE HOSPITAL CRPF HYDERABAD
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65. Thank you
Dr. G GANGADHAR RAO
STUDENT OF GUNTUR MEDICAL COLLEGE
FORMER PAEDIATRICIAN YASHODA HOSPITAL SEC.
Department of Pediatrics
COMPOSITE HOSPITAL CRPF HYDERABAD
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