Neonatal Resuscitation

-BLS-

RC 290

Equipment Needed

Overhead radiant warmerBulb syringeBVM with heated & humidified O2De Lee suction deviceSize 5 Fr suction catheters and wall suctionLaryngoscope with proper sized bladesProper sized ET tubesCrash cart/Drug box

Normal Delivery Procedures

Place under warmer and towel dryUse bulb syringe to clear mouth, than noseTactile stimulation if not breathing yet Auscultate heart and lungs & assess colorProphylactic silver nitrate or erythromycin drops in eyesVitamin K injectionExamine umbilical cordFree flow O2 as needed

Free Flow O2

Hold O2 connecting tubing ½ inch from infants face. Run flow at 5 LPM

Resuscitation

Maternal causes:– Drugs– Cardiopulmonary

problems– Infection– Dystocia– Utero-Placental problems

Fetal Causes– Cord compression– Prematurity– Congenital anomalies– Multiple pregnancy– Meconium aspiration– Hypothermia– shock

NRP Resuscitation Algorithm

Meconium Baby

Airway is aggressively cleared prior to drying if infant is meconium stained AND baby is NOT vigorous! – Use ET tube as a suction

deviceMay need PD & P after heart rate, respirations, and color stabilizeIf baby is meconium stained but vigorous, proceed with normal resuscitation

Bagging a Neonate

BVM Devices

BVM Devices

Flow-dependent anesthesia bag

Bagging Technique

Place infant in “sniffing” position by placing a small towel under the shouldersDo not hyperextend neck!

Bagging technique (cont.)

Apply correctly sized mask over infants mouth and nose with apex of mask over bridge of nose

Run either type of bag at 5-8 LPM to get 100% FIO2– If self-inflating bag, use reservoir also

Watch for slight rise of chest (Vt ~ 20-30 ml)Rate is 40-60 Pressure– First breath may require 30-40

cmH2O– Then, with normal lungs, 15-20

cmH2O– Poor lung compliance may require

sustained 20-40 cmH2O

If BVM ventilation lasts over 2 minutes…

Than an orogastric tube has to be inserted

Neonatal PD & P

Meconium babies and/or C section babiesNo more than 20 degrees of Trendelenberg or ICP will increasePercuss anterior and lateral surfaces 1-2 minutes

Maintain airway throughout using one hand on headSuction PRNBesides suction, need BVM and O2Monitor heart rate, respirations and color throughout

Neonatal PD & P Percussors

Neonatal Chest Compressions

Asystole or bradycardia less than 60 that is not increasing with airway and ventilationUse thumbs on lower half of sternum (one finger’s width below nipple line)Compress ½ to ¾ of an inch, 120 times per minuteCompression ventilation ratio is 3:1 (pause to give breath)

The End Result