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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 • • • • • • • 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 • • • • 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