Download NEONATAL RESUSCITATION

NEONATAL RESUSCITATION
Rachel Musoke
University of Nairobi
KNH/UON SYMPOSIUM 10TH Jan 2013
Poor intrapartum fetal oxygenation
• Also referred as asphyxia
• Common cause of death & long term disability
(mental & neurological)
• Estimated to contribute to 9% of all < 5
mortality (MDG 4)
• Burden of disease assessment – 42 million
disability-adjusted life years (DALYs)
Contributing factors
The delays
• Delay in recognition of the problem in the
mother
• Delay in transportation to a medical facility
• Delay in providing appropriate care at the
health facility
Solutions to reduce deaths &
disability
• Primary prevention – maternal care (early
recognition & management)
• Secondary prevention – appropriate neonatal
resuscitation
• Tertiary prevention – recognition &
management of acute complications
The Global Need for neonatal
Resuscitation, FIGO, Wall et al
Which babies need resuscitation?
Assess:
• Gestation – term or preterm?
• Breathing or Crying?
• Good tone?
• If NO then act quickly
–The first “golden minute”
The ABC of resuscitation
• Airway (Position and clear)
• Breathing (stimulate to breathe)
• Circulation (Majority of babies have normal
hearts)
• Warmth
Breathing
• Ventilation of baby’s lungs is the most
important and effective action in neonatal
resuscitation
Room air vs.O2 for Resuscitation
Term Infants
Pre-Term Infants
(< 32 weeks)
Room air or oxygen?
Term infants:
Mortality lower with room air vs 100% O2
Shorter recovery
Preterm
Balance the needs for oxygen vs possible
toxicity
Oxygen saturations at birth
1 minute
60-65%
2 minutes
65-70%
3 minutes
70-75%
4 minutes
75-80%
5 minutes
80-85%
10 minutes
85-95%
Meconium stained liquor
• Clear mouth & nose before drying &
stimulation to avoid aspiration
• Suctioning of the trachea reserved for
nonvigorous babies
Equipments
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Warmth towels & heater
Airway – suction catheters
Ventilate – bag (500ml). & masks (sizes)
Source of oxygen (& blender)
Auscultate – stethoscope
Pulse oximeter (if possible)
Intubation equipment
Key behavior skills
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Know your environment
Anticipate & plan
Call for help & work as a team
The person present must initiate
resuscitation
• Communicate effectively
• Use all available resources
SUMMARY
Effective Resuscitation
Airway & Breathing
Circulation
Drugs
Summary
• Everybody who conducts a delivery must be
able to resuscitate
• We should be prepared at all times
• Lets give our newborn a good start