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Outline the equipment that you need available at a resuscitation
Radiant warmer and light source, clock +/- timer
O2 supply with flow meter and tubing
warmed linen
Stethoscope
Pulse oximeter
Resuscitation system for positive pressure ventilation
Face masks, ETT, oropharyngeal airways, neopuff
Laryngoscope with straight blade, spare bulbs, batteries
Suction catheters and meconium suction device
Feeding tube and 20 ml syringe for gastric decompression
Umbilical catheterisation set, IV cannulas, syringes with needles
Explain the process of resuscitation of a neonate
Rub down with towel, try to stimulate them - temperature control, remove wet linen, dry the skin
Airways
Place infant on its back or side with head in neutral or slightly extended position
Clear upper airway - suction
Breathing - priority
Commence assisted ventilation if apneic, gasping, or if HR < 100bpm
Neopuff - 30-60 inflations per min
If bag-mask ventilation is unsuccewssful or prolonged - ETT (oral)
Circulation
Feel pulse - umbilicus, then listen
Initiate chest compression if: absent HR, HR < 60bpm despite adequate assisted ventilation for 30 secs
Compressions - lower 1/3 of sternum, compress 1/3 of the ap diameter of the chest
3:1 ratio of compressions to ventilation - 90 compressions and 30 bpm
Continue until HR > 60bpm
When is adrenaline indicated in neonatal resuscitation
If HR < 60bpm after 30 secs adequate ventilation and chest compression
0.1-0.3ml/kg of 1:10 000 solution IV, intracardiac or ETT
Repeat evert 3-5 mins if necessary
Risks of adrenaline in neonatal resuscitation
Intracranial haemorrhage
Myocardial damage
When should nalaxone be used in neonatal resuscitation?
if mother received narcotic analgesia in labour and infant has poor respiratory effort
0.1ml/kg - IM, IV, ETT
DON"T USE if mum is narcotic abuser - may precipitate abrupt infant withdrawal
assisted ventilation should be the priority though
When should sodium bicarbonate be used in neonatal resuscitation
For severe metabolic acidosis
Use only after adequate ventilation and circulation obtained
1-2mmol/kg of 0.5mmol/ml solution as a slow IV infusion
risks of giving sodium bicarbonate during neonatal resuscitation
hyperosmolarity
risk of IVH
Risk factors for asphyxia
Maternal:
Premature or prolonged rupture of membranes
Maternal disease - DM, chronic illness, infection, severe hypertension
Fetal
Prematurity or postmaturity
SGA, LGA
Rhesus isoimmunisation
Hydrops fetalis
polyhydramnios, oligohydramnios
intrauterine infection
Intrapartum
abnormal presentation
prolapsed cord
fetal distress
APH
Thick meconium staining of liquor
Assisted delivery
CS
Principles of nenoatal resuscitation
Anticipate the need for resuscitation
Airways
Breathing
Circulation
Drugs
Temperature control