Neonatal Resuscitation

Neonatal Resuscitation
By:Mary P. Martinasek, BS, RRT
Director of Clinical Education
Hillsborough Community College

Asphyxia
* Hypoxia + Hypercapnia + Acidosis
* May lead to irreversible brain damage
* The necessity to resuscitate is related to the degree of asphyxia

Causes of fetal asphyxia
* Maternal hypoxia
* Insufficient placental blood flow
* Blockage of umbilical blood flow
* Fetal disorders

Primary vs. Secondary Apnea
* Primary
o Initial asphyxia
o Signs
+ Initial period of rapid breathing
+ Respiratory movements cease
+ Heart rate and bp drop
+ Neuromuscular tone diminishes

Secondary Apnea
* If no resuscitation and apnea continues
* Signs
o Deep gasping respirations
o Heart rate continues to decrease
o Blood pressure begins to fall
o Infant flaccid

* Primary
o Stimulation and oxygen will usually induce respirations

* Secondary
o Infant unresponsive to stimulation – must be resuscitated

Effects of asphyxia on the lungs
* Ineffective respirations cannot open alveoli
* Pulmonary Hypertension
* Pulmonary vasoconstriction
o Hypoxia, hypercarbia, acidosis

Persistent Fetal Circulation
known as PPHN

* Leads to further asphyxia
* Blood shunted
* CO2 remains high despite ventilation
o Indocin
o Ligation of PDA

Preparation for Resuscitation

* Anticipation of high risk delivery
* Proper equipment
* Trained personnel

Purpose of Resuscitation

* Reverse asphyxia before irreparable damage has occurred

ABC’s of Resuscitation

* A – Establish an open airway
o Position infant
o Suction mouth then nose
* B – initiate breathing
o Use tactile stimulation
o Use PPV if necessary

Resuscitation

* C – Maintain circulation
o Stimulate and maintain circulation
+ Chest compressions
+ drugs

Initial steps
* Dry the infant
* Warm the infant
* Position the infant
* Suction the infant
* Stimulate the infant

Next step
* Evaluate respirations
o If none or gasping , provide PPV with 100% O2 for 15-30 seconds
o If spontaneous respirations then evaluate HR
* After 15-30 seconds of PPV or evaluation of spontaneous respirations then:
* EVALUATE HEART RATE
* If HR is above 100 then reevaluate respirations and color
* If HR is less than 60 continue/start PPV and start compressions

Reassess
* After 30 seconds reassess
* HR greater than 60 stop compressions
* HR greater than 100 and breathing stop PPV
* Evaluate infant’s color
o Peripheral vs. central cyanosis
o What is acrocyanosis?

Thermoregulation
* Maintain a neutral thermal environment
* Possible causes of heat loss
o Radiant
o Evaporative
o Convective
o Conductive

Neonatal Resuscitation.ppt