demonstrates the process of neonates' resuscitation

1. Neonatal Resuscitation
Prepared by:
Sarah Emad
Shadan Khorsheed
Al kindy college of
Medicine
University of Baghdad

2. Neonatal Resuscitation
Neonatal resuscitation skills are essential for all health care
Providers who are involved in the delivery of newborns.
- The transition from fetus to newborn requires intervention
In 10% of deliveries
-Perinatal asphyxia and extreme prematurity frequently
Necessitate complex resuscitation

3. Chinese emperor and philosopher Hwang‐Ti (2698–
2599 BC) noted that newborn death from ventilatory
failure occurred more commonly among infants born
prematurely
Increased mortality among premature infants was also
reported in Eber's Papyrus in Egypt (1552 BC),
Hippocrates (460–380BC) described intubation of the
trachea of humans to support ventilation.

4.  1960’s Mechanical ventilation
1970’s Neonatal intensive care units
 1985 NRP Neonatal resuscitation program
 1992 international collaboration

6. Embryonic stages of lung development

7. Fetal pulmonary physiology
At term, the fetal lung is filled with approximately 20 ml
Of fluid secreted by pulmonary epithelium
This fluid maintains lung volume at about FRC
 The placenta provides the respiratory function for the
fetus
 Fetal breathing begins at 11 weeks’ gestation

8. Neonatal pulmonary physiology
How lung fluid is removed ?!
 During delivery
 Thoracic compression
 Lymphatic drainage
 Readsorption
 After Birth
 evaporation
 lymphatics
 ion transport

9. Fetal circulation
• The umbilical vein carries the oxygenated blood
From the placenta to the fetus
• only 12% of the blood from the right ventricle enters
The lungs

10. Neonatal circulation
 Clamping of umbilical cord removes the low resistance
Placental vascular circuit and thereby raises systemic
Vascular resistance

11. Antepartum factors
 Maternal diabetes
 gestational hypertension or preeclampsia
 chronic hypertension
 fetal anemia or isoimmunization
 previous fetal or neonatal death
 bleeding in 2nd or 3rd trimester
 maternal infection
 maternal cardiac, renal, pulmonary, thyroid
Or neurologic disease
 polyhyramnios
 oligohydramnios
 PROM
 fetal hydrops
 post term gestation
 multiple gestation
 size-dates discripancy
 drug therapy
 maternal substance abuse
 fetal malformation
 diminished fetal activity
 no prenatal care
 mother older than 35 years

12. Intrapartum factors
•Emergency cesarean section
•Assisted delivery
•Breech or other abnormal presentation
•Premature labour
•Chorioamnionitis
•Prolonged ROM more than 18 hours
•Prolonged labor more than 24 hours
•Macrosomnia
•Use of general anasthesia
•Narcotics to mother within hours of delivery
•Meconium stained amniotic fluid
•Prolapsed cord
•Abruptio placentae
•Placenta previa
•Significant intrapartum bleeding

13. Neonatal Resuscitation
Program, jointly developed
By American Academy of
Pediatrics AAP and American
Heart Association AHA

15. Factors that lead to increase heat losses in newborn
Large surface area
Transdermal water loss
Limited capacity to change body position
Incapable of effective shivering
Environmental temprature
Using unheated nonhuumidified oxygen sources during resscitation

16. The infant should be positioned as
To open the airway
A bulb syringe should be used for
Initial suctioning
Suctioning with a catheter should be
Limited to patients with thick mucous
aspiration

17. Slapping the sole of the feet or rubbing the
Back can be effective

18. Infants who do not meet the criteria for routine care
Or have difficulties with respiratory effort, tone or color
May need further intervention

19. Positive pressure ventilation

20. Intubation
Suctioning
Medications
Prolonged assisted
Ventilation

21. Candidates
Maneuver
3:1
When to stop it

22. Medications

23. Pre-rescucitation Preparation
SkillsEquipment
Personnel

24. Equipment
Quick
Checklist
Warm
Preheat Warmer
Towels or Blankets
Clear Airway
Bulb syringe
10F or 12F suction catheter attached to wall
suction set at 80-100 mm Hg
Meconium Aspirator
Auscultate Stethoscope
Oxygenate
Method to give free-flow oxygen (mask, tubing,
flow-inflating bag or T-piece)
Gases flowing just prior to birth, 5 – 10 L/min
Blender set per protocol
Pulse oximeter probe (detached from oximeter until
needed)
Pulse oximeter
Ventilate
Positive-pressure ventilation (PPV) device(s)
present with term and preterm masks
PPV device(s) functioning
Connected to air/oxygen source (blender)
8F feeding tube and 20-mL syringe
Intubate
Larynscope
Size 0 and Size 1 (and size 00, optional) blades
with bright light
Endotracheal tubes, sizes 2.5, 3.0, 3.5, 4.0
Stylets
End tidal CO2 detector
Laryngeal mask airway (size 1) and 5-mL syringe
Medicate
Access to 1:10,000 epinephrine and normal saline
Supplies for administering meds and placing
emergency umbilical venous catheter
Documentation supplies
Thermoregulate
Plastic bag or plastic wrap
Chemically activated warming pad
Transport incubator ready
Other

28. Senario #1
A baby just born
Term?.........Yes
Breathing or crying?….Yes
Good tone?.....yes

30. Senario #2
A baby just born:
Term?.........Yes
Breathing or crying?….Yes
Good tone?.....Yes
*Cyanosed

32. Senario #3
A baby just born:
Term?.........Yes
Breathing or crying?…NO

33. Special Complications

34. Failure of PPV
M: Mask adjustment.
R: Reposition airway.
S: Suction mouth and nose.
O: Open mouth.
P: Pressure increase.
A: Airway alternative.
MR SOPA

35. Airways Blockage
• Coanal atresia
• Robin Syndrom

36. Impaired Lung Function
• Pneumothorax
• Congenital
• Diaphragmatic
• hernia

37. If remains cyanotic
If remains bradycardic
O2 100%
???

38. Problems in prematurity:
1)Skin
2)Respiratory
3)Brain
4)Muscles
5)Tissues

39. Prematurity

40. Multiple Pregnancy

42. Contraversies
1) Hypothermia.
2) Artificial Surfactant.
3) Suction for meconium aspiration
4) Room air versus O2 100%