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PRIMARY CAUSE OF DEATH
18 %Other causes
29 %Perinatal hypoxia
4 MILLION NEWBORN DEATHS – WHY?
ALMOST ALL ARE DUE TO PREVENTABLE
Basic Life Support needed for patient whose
breathing or heart has stopped
Ventilations are given to oxygenate blood
when breathing is inadequate or has stopped
If heart has stopped, chest compressions
are given to circulate blood to vital organs
Ventilation combined with chest
compressions is called cardiopulmonary
CPR is commonly given to patients in
cardiac arrest as a result of heart attack
Intra partum factors
Post partum factors
Post term gestation
Maternal drug abuse
Like respiridine, lithium, carbonate
Early rupture of membranes.
Foul smelling amniotic fluid.
Meconeum stained amniotic fluid.
Narcotic administration to mother
with in 4 hrs of delivery.
ABC’s of Resuscitation
A - establish open airway Position,
B - initiate breathing by Tactile
C - maintain circulation Chest
D - Medications
A B C (A: Airway, B: Breathing, C: Circulation)
• Initial steps:
Sign 0 1 2
Heart rate Absent <100
Respirations Absent Weak cry Strong cry
Muscle tone Limp Some flexion Active motion
Reflex No response Grimace Active
Color Blue, pale Body: pink
3. Initial stabilization and evaluation.
4.Timely recognition, Quick and
are critical for the success of
•Resuscitation must be
anticipated at every birth.
•Every birth attendant should
be prepared and able to
For resuscitation:For resuscitation:
1. A self-inflating Ambu bag (newborn size)
2. Two infant masks (for normal and small
3. A suction device (mucus extractor),
4. A radiant heater (if available), warm
towels, a blanket and
5. A clock are needed
This consists of :This consists of :
drying, (thermal management) positioning
the neonate under radiant warmer to
minimize heat loss, suctioning of mouth
and nose (Tracheal suctioning if meconium
present) and provide tactile stimulation.
This should only take approximately 20
(1)Open the airway(1)Open the airway
•Put the baby on its back
•Position the head so that it is
slightly extended .
The upper airway
(the mouth then the nose) should
be suctioned to remove fluid if
stained with blood or meconiumblood or meconium
If the chest is rising symmetrically
with frequency >30/minute,
no immediate action is needed
(2) If there is no cry,(2) If there is no cry,
assess breathing:assess breathing:
If the newborn is not breathing or
Immediately start resuscitation.
There are two techniques to provide
1.Technique for artificial respiration
2.Positive pressure ventilation.
1.Technique for artificial
• CLEAR THE MOUTHOF MUCOUS.
• HYPER EXTEND THE NECK WITH
ONE HAND, CLAMP THE
NOSTRILS WITH FINGERS OR
• SEAL NOSE AND MOUTH OR
• TAKE DEEP BREATH AND FORCE
AIR INTO LUNGS.
When no equipment is
mouth to mouth-and-nose
should be done.
for ensuring adequate ventilation of the
lungs, oxygenation of vital organs, and
initiation of spontaneous breathing.
The most important aspect ofThe most important aspect of
newborn resuscitationnewborn resuscitation
Ventilation can almost always be initiated
using a bag and mask.
2 basic kinds of resuscitation bags are
Self inflating bag
Flow inflating bag
(it is rarely necessary to intubate)
OUT LINE PROCEEDURE TO
•Select the appropriate mask
Reposition the newborn
•Make sure that the neck is
•Place the mask on the newborn's
face, so that it covers the chin,
mouth and nose .
• Form a seal between the mask and the
infant's face. Squeeze the bag with two
There should be noticeable rise and fall
of chest with each inflation .
EVALUATE THE HEART RATE
After 30 sec , count the heart rate for 6sec and
multiply it by 10 to obtain heart rate per mt.
If the HR is >100bpm and infant has spontaneous
respirations discontinue ventilation, provide tactile
stimulations and free flow oxygen.
If HR is <100 bpm ensure ventilation with 100%
oxygen initiate chest compression.
When ever the HR remains < than 60bpm inspite of
positive pressure ventilation.
2 types :
II.TWO FINGER TECHNIQUE
oPressure to be applied vertically.
oCannot use effectively if the baby is large or if our
hands are small.
oPosition of the baby on firm surface with neck
lower third of sternum which lies between
the xyphoid and the line drawn between
Depth of compression:
Infant: 1/2-3/4 ‘’
Compression and ventilation rates and ratios:
For adult-30 compression and 2 breaths.
For infant and child-15:2
• Place thumbs of both hands on sternum while
fingers encircle chest
• Compress breastbone with both thumbs while
fingers support the back.
Two-Rescuer CPR: Infants
Rescuer 1 checks
ABCs. Rescuer 2
locates site for chest
•After effectively ventilating for about
1 minute, stop briefly but do not
remove the mask and bag and look for
•If there is none or it is weak, continue
ventilating until spontaneous
If breathing is slow (frequency
of breathing is <30), or if there
is severe chest indrawing:
continue ventilating and ask for
arrangement for referral if
A newborn will benefit
from transfer only if it is
properly ventilated and
kept warm during transport
If there is no gasping or
breathing at all after 20
minutes of ventilation:
•Do not separate the mother and
•Leave the newborn skin-to-skin
with the mother
•Encourage breast-feeding within one
hour of birth.
•The newborn that needs resuscitation
is at higher risk of developing
•Observe suckling .
Good suckling is a sign of good
1.Stimulate the heart so that it supplies
oxygen, nutrition to the body and vital
2.Increase tissue perfusion
3.Restore acid-base balance.
Drugs are seldom needed to:
They may be required in
newborns who do not respond
to adequate ventilation with
100% oxygen and chest
Sodium bicarbonate is not
recommended in the immediate
if there is no documented
It should therefore not be
to newborns who are not
If it is given administer 2meq/kg
Slowly not faster than a rate of 1meq/kg/mt.
Epinephrine in a dose of 0.01-0.03
mg/kg should be administered if the
heart rate remains <60 bpm after a
minimum of 30 seconds of adequate
ventilation and chest compressions.
Routes: umblical vein,
TO BE INFUSED OVER 5-10 MTS.
can serve as an alternative route for
medications/volume expansion if
umbilical or other direct venous
access is not readily available.