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Resuscitation of new born
1. “Resuscitation of New Born”
presented by
DR. ZEESHAN SAJID
MCPS Trainee, Paeds Medicine
2. About 10% of all new born require some
assistance to begin breath just after
delivery.
1% of them require extensive resuscitation
3. Preparation for high risk
delivery.
Is the key to a successful outcome.
Cooperation between obstetric and
pediatric staff is important.
Estimation of gestational age,weight
Resuscitative measures discussed with
parents.
4. Equipments for resuscitation
Resuscitation table
Sterile linen
Suction apparatus (suction catheter #5 or
6,8,10 Fr. )
Laryngoscope with straight blade #0, #1
Ambu bag and face mask
Oral airways
Oxygen with flow meter and tubing
Endotracheal tubes # 2.5,3.0,3.5 & 4.0
7. The fundamental principles
include
placed under a radiant heater
Dry the baby
positioned head down and slightly
extended
the airway cleared by suctioning,
gentle tactile stimulation provided
(slapping the foot, rubbing the back).
Simultaneously, the infant's color, heart
rate, and respiratory effort should be
assessed
9. The steps in neonatal
resuscitation follow the ABCs
A, anticipate and establish a patent airway
by suctioning and, if necessary, performing
endotracheal intubation
B, initiate breathing by using tactile
stimulation or positive-pressure ventilation
with a bag and mask or through an
endotracheal tube
C, maintain the circulation with chest
compression and medications, if needed
10. Steps to follow for
immediate neonatal
evaluation and resuscitation
are
17. TUBE
SIZE (mm
ID)
DEPTH OF
INSERTION FROM
UPPER LIP (cm)
WEIGHT (g) GESTATION
(wk)
2.5 6.5-7 <1,000 <28
3 7-8 1,000-2,000 28-34
3/3.5 8-9 2,000-3,000 34-38
3.5/4.0 ≥9 >3,000 >38
Guidelines for Tracheal Tube Size
and Depth of Insertion
18. MECONIUM.
Meconium staining of the amniotic fluid
may be an indication of fetal stress
the obstetrician should suction the mouth,
nose, and hypopharynx immediately after
delivery of the head but before delivery of
the shoulders
19. Contd.
If the infant is vigorous with good
respiratory effort and a heart rate
>100/min, tracheal intubation to aspirate
meconium should not be attempted and
the mouth and nose should be suctioned
with a bulb or suction catheter.
If the infant is depressed with poor muscle
tone and/or a heart rate < 100/min,
tracheal intubation and suctioning should
be performed.
20. Contd.
The endotracheal tube should be attached
to a suction device and free flow oxygen
should be provided throughout the
procedure.
21. Medications
Medications are rarely required but should
be administered when the heart rate is <
60/min after 30 sec of combined
ventilation and chest compressions or
during asystole
The umbilical vein can generally be readily
cannulated and used for immediate
administration of medications during
neonatal resuscitation
22.
23. The endotracheal tube may be used for
the administration of epinephrine if
intravenous access is not available and/or
for naloxone hydrochloride
24. Epinephrine(0.1–0.3 mL/kg of a 1 : 10,000
solution, intravenously or intratracheally)
is given for asystole or for failure to
respond to 30 sec of combined
resuscitation. The dose may be repeated
every 3–5 min.
Emergency volume expansion is
accomplished with 10–20 mL/kg of an
isotonic crystalloid solution or O-negative
red blood cells (in acute hemorrhage).
25. Soda bicarb should be given slowly (1
mEq/kg/min) if metabolic acidosis has
been documented and the resuscitation is
prolonged.
Naloxone hydrochloride is given if there is
H/O maternal narcotic administration with
in past 4 hrs. dose 0.1mg/kg thru
endotracheal,IV,IM or S/C.
Dopamine is indicated after prolonged
resuscitation if infant has poor peripheral
pulses,poor perfusion and continues to
show evidence of shock.dose 5-
20µg/kg/min
26. Discontinue resuscitation if there is no
respiratory activity or heart is inaudible
and pupils are dilated and fixed after 20
min of resuscitation
