This ppt will help MBBS students.

1. NEWBORN CARE

2. OVERVIEW
 10% of newborns require some assistance
to begin breathing at birth
 <1% require extensive resuscitative measures

4. WHAT QUESTIONS SHOULD YOU ASK
BEFORE EVERY BIRTH ?
 What is the expected gestational age ?
 Is the amniotic fluid is clear ?
 How many babies are expected ?
 Are there any additional risks factors ?

5. BEFORE BIRTH
1 Anti-natal counseling:

7.  Every birth should be attended by at least
qualified individual, skilled in the initial steps of
new born care and ppv, whose only responsibility
is management of newly born baby.
 If risk factor are present at least two qualified
people should present solely to manage the
baby.
 A qualified team with full resuscitation skills
should be available for every resuscitation.
2 Team Briefing:

8. Team Briefing
When team assembled
Review risk factor and management plans
Assign roles and responsibilities to every member
Identify team leader

9. 3 Equipment Checklist:

10. 3 QUESTIONS TO ANSWER WITH
YES/NO
Term gestation?
Crying or breathing?
Good muscle tone?

11. YES !
 Term gestation
 Crying or breathing
 Good muscle tone
baby does not need
resuscitation
should not be
separated from the
mother.
dry, place skin-to-skin
with the mother
cover with dry linen to
maintain temperature
Observe breathing,
activity, and color

12. NO ?
 Term gestation?
 Crying or breathing
 Good muscle tone?
Initial steps in
stabilization(provide
warmth, clear airway if
necessary, dry,
stimulate)
Ventilation
Chest compressions
Administration of
epinephrine and/or
volume expansion

13. The Golden minute
• The “first minute after birth”
• Anxiety for parents and health providers
• Period of transition from intrauterine to extra uterine life
• First Golden Minute Project: skill based training

14. The Golden minute
• <30 seconds: complete initial steps
• Warmth
• Drying
• Clear airway if necessary
• Stimulate
• 30-60 seconds: assess 2 vital characteristics
• Respiration (apnea/gasping/labored/unlabored)
• Heart rate (<100/>100bpm)

15. CORD CLAMPING
“Early” cord clamping is generally carried out in
the first 60 seconds after birth (generally within
the first 15-30 seconds), whereas “delayed”
umbilical cord clamping is carried out more than
1 min after the birth or when cord pulsation has
ceased.

16. INITIAL STEPS OF NEW BORN CARE
 Vigorous, term new born
Initial steps on mothers chest or abdomen
 Non vigorous and pre-term new born
Baby should brought to radiant warmer.

17. INITIAL STEPS OF NEW BORN CARE
 Provide warmth
- Temperature should be between 36.5 °C – 37.5°C
- Apply a servo controlled temperature sensor to
the baby’s skin to monitor and control baby’s
temperature.
 Position:
Position the head and neck to open the airway-
”Sniffing the morning air” position

18. INITIAL STEPS OF NEW BORN CARE
Correct: “sniffing” position INCORRECT: Hyperextension
INCORRECT: Flexion Optional shoulder roll for maintaining
the “sniffing” position

19. INITIAL STEPS OF NEW BORN CARE
 If needed clear secretions from airway
- If the baby:
a) is not breathing
b) is gasping
c) has poor tone
d) secretion are obstructing the airway
e) difficulty in clearing the secretions
f) having meconium stained fluid
g) anticipate ppv.

20. INITIAL STEPS OF NEW BORN CARE
 How to remove secretions ?
- Gentle suctioning with a bulb syringe
- Suctioning of the mouth first and then nose.

23. INITIAL STEPS OF NEW BORN CARE
 Dry :
- Place the baby on warm towel or blanket.
- Gently dry any fluid.
- Not necessary for very pre-term babies less
than 32 weeks gestation because they should
be covered immediately in polyethylene plastic.
 Stimulate:
- Gently rub the new born back, trunk or limbs.
- Never shake the baby

24. ASSESSMENT OF HEART RATE
 Immediately after birth, assessment of the
newborn’s heart rate is used to evaluate the
effectiveness of spontaneous respiratory effort
and determine the need for subsequent
interventions.
 During resuscitation, an increase in the
newborn’s heart rate is considered the most
sensitive indicator of a successful response to
each intervention

25.  During resuscitation of term and preterm
newborns, the use of 3-lead ECG for the rapid
and accurate measurement of the newborn’s
heart rate may be reasonable.
 Use of ECG does not replace the need for pulse
oximetry to evaluate the newborn’s oxygenation.
ASSESSMENT OF HEART RATE

26. ASSESSMENT OF OXYGEN NEED AND
ADMINISTRATION OF OXYGEN
 It is recommended that oximetry be used when
resuscitation can be anticipated, when PPV is
administered, when central cyanosis persists
beyond the first 5 to 10 minutes of life, or when
supplementary oxygen is administered.

28. Apnea or Gasping and HR below 100 pm
?

29. POSITIVE PRESSURE VENTILATION
 Indications:
- apneic or gasping
- heart rate <100 per minute
- oxygen saturation below the target range
despite free flow oxygen or CPAP
- should be started within 1 minute of birth.

30. POSITIVE PRESSURE VENTILATION
Pressure tracing during 3 positive-pressure breaths. PIP 5 Peak inspiratory pressure, PEEP
5 positive end-expiratory pressure, IT 5 inspiratory time.

31. POSITIVE PRESSURE VENTILATION
 Check :
- Heart rate response to ppv
- chest movements
- attach a pulse oximeter

32. PPV Devices
Self-inflating bag. Fills spontaneously. Does not need compressed gas or a
tight seal to fill.

33. PPV Devices
Flow-inflating bag. Requires compressed gas and a tight seal to fill.

34. PPV Devices
T-piece resuscitator. Requires compressed gas to function. Pressures are set by
mechanical controls on the device.

35. PREPRATION
 Clear secretion from airway.
 Position yourself at baby’s head.
 Position baby’s head and neck.

36. POSITIONING OF MASK
1. Select the correct mask:

37. POSITIONING OF MASK
2. Place the mask on the baby’s face.
(A) Cup the chin in the mask. (B) Bring the mask over the mouth and nose.
Maintaining a seal with the 1-hand technique using an anatomic mask (A) or a round mask (B).
i) One-Hand Technique

38. POSITIONING OF MASK
ii) Two-Hand Technique With Jaw Thrust

39. PRECAUTIONS
 Do not “jam” the mask down on the face.
Too much pressure can obstruct the mask,
cause air to leak around the side of the
mask, inadvertently flex the baby’s neck, or
bruise the face.
 Not to rest your hand on the baby’s eyes.
 Not to compress the soft tissue of the
baby’s neck.
 Recheck the position of the mask and the
baby’s head at intervals.

40. CONCENTRATION OF OXYGEN IN PPV
 Greater than or equal to 35 weeks’ gestation -
21% oxygen
 Less than 35 weeks’ gestation - 21% to 30%
oxygen.
 Set the flowmeter to 10 L/minute

41. VENTILATION RATE IN PPV
 Breaths should be given at a rate of 40 to 60
breaths per minute.
 Use the rhythm, “Breathe, Two, Three; Breathe,
Two, Three; Breathe, Two, Three.”

42. PRESSURES USED TO START PPV
 Goal :
- use enough pressure to inflate and aerate the
lungs to increase heart rate and oxygen
saturation.
 PIP of 20 to 25 cm H2O
 PEEP initial setting is 5 cm H2O.

43. EVALUATE THE BABY’S RESPONSE TO
PPV
 The most important indicator of successful PPV
is a rising heart rate.
 Check the baby’s heart rate after 15 seconds of
PPV:
- If heart rate is increasing continue PPV and do
your second assessment of the baby’s heart
rate after another 15 seconds.
- If hear rate is not increasing check for chest
movement with the assisted breaths and report
the findings.

44.  Heart rate not increasing - Chest IS moving
• Announce “Chest IS moving.”
• Continue PPV that moves the chest.
• Do your second assessment of the baby’s
heart rate after another 15 seconds of PPV that
moves the chest.
 Heart rate not increasing - Chest is NOT
moving.
• Perform the ventilation corrective steps until
you achieve chest movement with ventilation.
• Alert the team when chest movement has been
achieved.
• Continue PPV that moves the chest.
• Do your second assessment of the baby’s
EVALUATE THE BABY’S RESPONSE TO PPV

45. VENTILATION CORRECTIVE STEPS: MR.
SOPA
 Leak around the mask
 Airway obstruction
 Insufficient ventilating pressure.
Perform the corrective steps until achieve
the chest movement.
Why to Use ?

46. VENTILATION CORRECTIVE STEPS: MR.
SOPA
Try PPV and assess chest movement and breath sounds.

47. FIRST HEART RATE ASSESSMENT

48. SECOND HEART RATE ASSESSMENT

49. CONTINUOUS POSITIVE AIRWAYS PRESSURE
(CPAP)
If the baby is breathing spontaneously and has a heart rate at
least 100 bpm, but has labored respirations or low oxygen
saturation, CPAP may be helpful. CPAP is NOT appropriate
therapy for a baby who is not breathing spontaneously or whose
heart rate is less than 100 bpm.

50.  Laboured breathing or low oxygen staturation.
 Surfactant deficiency.
 Retained fetal lung fluid.
CONTINUOUS POSITIVE AIRWAYS PRESSURE
(CPAP)
INDICATIONS:

51.  CPAP during the initial stabilization period
- CPAP is administered by making a tight seal between the baby’s face and a
mask attached to either a T-piece resuscitator or a flow-inflating bag.
CONTINUOUS POSITIVE AIRWAYS PRESSURE
(CPAP)
(A) and flow-inflating bag (B). The manometer shows the amount of CPAP administered.
A tight seal must be maintained with the mask.

52.  CPAP after the initial stabilization period
If CPAP will be administered for a prolonged period, you will use nasal prongs
or a nasal mask. After the initial stabilization, CPAP can be administered with
a bubbling water system, a dedicated CPAP device, or a mechanical
ventilator.
CONTINUOUS POSITIVE AIRWAYS PRESSURE
(CPAP)
CPAP administered to a preterm newborn with nasal prongs.

53. FREE FLOW OXYGEN
 Given through the tail of an open reservoir.
 Can be given via the mask of a flow-inflating bag
or T-piece resuscitator
 Indications:
- Persistent central cyanosis.

54. FREE FLOW OXYGEN
(A) INCORRECT. Free-
flow oxygen CANNOT be
given reliably through the
mask of a self-inflating
bag.
(B) ​CORRECT method for
administering free-flow
oxygen using the open tail
reservoir of this self-
inflating bag
(A) Free-flow oxygen with
a flow-inflating bag. The
mask is held above the
face without forming a
seal.
(B) Free-flow oxygen with
a T-piece resuscitator. The
opening on the cap is not
occluded. The mask is
held above the face
without forming a seal.

55. ENDOTRACHEAL INTUBATION
(A). This tube has a vocal cord guide that is used to approximate the insertion depth
(B). The tube is inserted so that the vocal cords are positioned in the space between
the double line and single line (indicated by the arrows). The vocal cord guide is only
an approximation and may not reliably predict the correct insertion depth.

56. ENDOTRACHEAL INTUBATION
Endotracheal tube size for babies of various weights and gestational ages

57. ENDOTRACHEAL INTUBATION
Correct (A) and incorrect (B
and C) positioning for
intubation

58. ENDOTRACHEAL INTUBATION
Indications for intubation
 Meconium suctioning in non vigorous baby
 Diaphragmatic hernia
 Prolonged PPV
 Ineffective B & MV
 Elective
< 1Kg of weight of baby

59. LMA(Laryngeal mask airway)
• Fits over laryngeal inlet
• Done when BMV is unsuccessful
• When tracheal intubation is unsuccessful or
not feasible

60. LMA(Laryngeal mask airway)