Neonatal Resuscitation.

Published on July 2016 | Categories: Documents | Downloads: 42 | Comments: 0 | Views: 284
of 18
Download PDF   Embed   Report

A detailed explanation on Neonatal rususcitation. A must for every Pediatrician!




Course coordinator :Dr.T.Himabindu Singh
Department of Neonatology, Osmania Medical College
Acknowledgments: Dr.Suchitra,Assisstant Professor of Paediatrics.
National Neonatology Forum
Faculty of Institute of Child Health, Niloufer Hospital
Indian Academy of Pediatrics, Twin Cities Branch.

This material is meant to act as a guide to learn the theory of certain essentials of the subject
matter, on which, the reader can build thereon.
In the Workshop certain practical aspects (and definitely not all) will be demonstrated and will
be provided for hands-on experience.

This material has been collected from sources trusted to be authoritative.
OSMECON and its Organisers do not assume any liability of any kind thereof.

Neonatal Resuscitation Program

What is NRP ?
The Neonatal Resuscitation Program (NRP) is an educational program adapted to India by
Indian Academy of Paediatrics and National Neonatology Forum from the American Heart
Association (AHA).
Who are the persons requiring NRP?
The course has been designed to teach an evidence-based approach to resuscitation of the
newborn to those who care for newborns at the time of delivery. Since the inception of the NRP
in 1987, millions of Health Care Providers have been trained NRP.
Why is NRP gaining importance?
Around 3,09,000 babies die within 24 hours of their birth each year in the country from
infections and other preventable causes, according to a report by an NGO Save the Children.
India tops the list of countries having the most first-day deaths of children and is ahead of only
Nigeria, Pakistan and China. What more, India accounts for 29 per cent of all newborn deaths
worldwide, the study claims.
The ‘State of the World’s Children 2013’ ranks India at 49th place out of 195 countries in U5MR,
which is a crucial indicator of health and well-being of children.
What do we learn from NRP?
The NRP Provider Course introduces the concepts and basic skills of neonatal resuscitation. It is
designed for health care professionals involved in any aspect of neonatal resuscitation,
including physicians, nurses, advanced practice nurses, nurse midwives, licensed midwives,
respiratory care practitioners, and other health care professionals who provide direct care
during neonatal resuscitation.
In view of the above facts its time for us to give the best services to prevent neonatal
mortality and decrease morbidity by acting on time.” lets give a healthy life to our future

Primary cause of newborn deaths: NNPD

4 million newborn die.
Almost all are due to preventable conditions.

Neonatal resuscitation
As soon as the baby is delivered, in the first golden minute in the labour room one should
assess immediate cry/breathing. If breathing well, proceed for routine new born care. If not
breathing, proceed for effective resuscitation with in a minute after birth. Most new borns cry
immediately and require only routine new born care. Only 10% of new borns may require
resuscitation and only 1% require advanced resuscitation like chest compressions and

Preparation for Resuscitation
Labour room should be warm 250C, Close doors and windows, Off Air conditioners and fans
Prepare new born care corner with overhead warmer 280C
Identify help, inform contact numbers for referral to helper
Wash hands properly for 2 minutes
Prepare and check equipment necessary for resuscitation

When resuscitation is required ? after delivery on the mothers abdomen
Not breathing/crying
Meconium stained non vigorous baby (meconium stained vigorous baby proceed for
routine care)
Assess for prematurity, colour.
Important points:
 If a baby does not breathe immediately after being stimulated >>> secondary apnea
 Assume every apneic baby is in secondary apnea
 Longer the duration of compromise, longer it takes for recovery
Evaluation: By 3 signs
1. Respiration

Breathing / crying


2. Heart rate

<100 or not

< 60 or not

3. Color

Central cyanosis

Peripheral cyanosis / pink

Key principles
 Anticipate
 Prepare
 Universal precautions

Routine New Born Care

Conduct delivery on the mothers abdomen
Assess breathing - if breathing well
Wipe the baby dry – no bathing upto 24hrs
Cut the umbilical cord with in 1-3 minutes, nothing to be applied on the cord
Cover the baby head wipe the eyes
Keep the baby on the chest of the mother with skin to skin contact
Initiate breastfeeding immediately
Inform mother to report in case of abnormal breathing/hypothermia/other danger signs

Initial steps of Resuscitation – If the baby is not breathing well / non vigorous
Inform mother and shift the baby under the warmer in the new born care corner.
Position with slight extension of the head in sniffing position with a shoulder roll.
If meconium stained and non vigorous, intubated and secretions cleared by low suction
If not meconium stained, clearing of secretions from mouth first and then nose by low suction
Wiping the baby dry, remove wet linen and cover with another dry warm linen.
Gentle physical stimulation like flicking/slapping the feet and rubbing the back of the baby.
Reposition the baby and assess breathing.
If not breathing with initial steps of resuscitation for 30 seconds, proceed for positive pressure
ventilation with self inflating bag and mask.

Provide warmth
 Avoid hypothermia
 VLBW may require special efforts

 Polyethylene bags
 Avoid hypothermia

Position, clear airways
(as necessary)

Dry, stimulate, reposition

Oxygen: term babies
 Use 100%: if cyanosis or PPV required
 Less than 100%: possibly also effective
 If resuscitated with less than 100% oxygen: administer O2 up to 100% if no
appreciable improvement within 90 sec following birth
 If supplemental O2 is unavailable: use room air
Oxygen: preterms (<32 wk)
 Use blender and pulse oximeter
 Begin PPV with FiO 2 0.21-1.0
 Adjust O 2 to achieve SO2 of 95%
 Decrease O 2 if SO2 above 95%.
 If HR <100 bpm: correct ventilation & use 100% O 2
 If no facility of blender & pulse ox: manage as term babies

 No convincing evidence that a brief period of 100% oxygen during resuscitation will be

Bag & Mask Ventilation
Positive pressure ventilation
Ventilation of the lungs
single most important and most effective step in cardiopulmonary resuscitation of the
compromised newborn
A good resuscitation bag
 Size 200-750 ml
 Capable of avoiding excessive pressure
 A pressure pop-off valve and/or a pressure gauge manometer
 Capable of giving 100% oxygen
 Appropriate sized mask
Resuscitation bags
 Two types
 Flow inflating bag (anesthesia bag)
 Self inflating bag
Flow inflating bag
 Fill only when oxygen from a compressed source flows into them
 Depend on a compressed gas source
 Must have a tight face-mask seal to inflate
 Use a flow-control valve to regulate pressure-inflation
Flow inflating bag will not work if
 The mask is not properly sealed over the newborn’s nose and mouth

 There is a tear in the bag
 The flow-control valve is open too wide.
 The pressure gauge is missing
Flow inflating bag
 Delivers 100% oxygen at all times
 Easy to determine the adequacy of seal
 “Stiffness” of lungs can be felt
 Can be used to deliver 100% free flow oxygen
Flow inflating bag
 Requires a tight seal to remain inflated
 Requires a gas source to inflate
 No safety pop-off valve
 Requires more experience
Self inflating bag (more widely used in resuscitation of new borns)

Self inflating bag
 Fill spontaneously after they are squeezed, pulling oxygen or air into the bag
 Remain inflated at all times
 Can deliver positive-pressure ventilation without a compressed gas source; user must be
certain the bag is connected to an oxygen source for the purpose of neonatal
 Require attachment of an oxygen reservoir to deliver 100% oxygen
Without Reservoir

With Reservoir

Self inflating bag
 Does not need a gas source to inflate
 Pressure release valve
 Easier to use
Self inflating bag
 Will inflate even without adequate seal
 Requires a reservoir to deliver 100% oxygen
 Can not be used to deliver 100% free flow oxygen

 Cushioned/Non-cushioned
 Round/Anatomical shaped
 Size 0 or 1

Correct position of mask

Testing the self-inflating bag
 Squeeze against your palm
 Pressure felt
 Pressure release valve
 Pressure manometer
 Re-inflation
Chest compressions

 If after 30 seconds of effective bag and mask ventilation with 100% oxygen,
heart rate is below 60 per minute
When to stop
chest compressions
 When heart rate is 60 per minute or more
 Lower third of sternum
 Between nipple line and xiphisternum
Rate & adequacy
 3 CC then 1 ventilation (1:3)
 90 CC to 30 ventilation in one minute
 Palpate femoral/carotid pulse
Cycle of events
 One – and – two –and – three – and – breathe – and
 Consists of 3 compression & one ventilation
 120 events in 60 seconds
 1 cycles in 2 seconds
Problems in chest compressions
 Broken ribs
 Lacerated liver
 Pneumothorax

 No pressure on the ribs, xiphisternum, abdomen
Do not lift thumbs/fingers
Evaluation after 30 sec of
 HR 60 per minute or more Stop CC, continue BMV at 40-60/min
 If no improvement, check :
 Effectiveness of BMV
 Oxygen is 100%
 Technique of CC is correct
When to stop resuscitation?
 No heart rate after 10 minutes of complete and adequate resuscitation
 No evidence of other causes of compromise.

Sponsor Documents

Or use your account on


Forgot your password?

Or register your new account on


Lost your password? Please enter your email address. You will receive a link to create a new password.

Back to log-in