Newborn resuscitation

programme(NRP)
Renu Singh

Burden of the problem

Birth asphyxia
23% of the 1 million neonatal deaths in
India
Long term neurological complications
Death
NNR (Neonatal resuscitation) :simple,
inexpensive, cost effective method
Problem: NNR often not initiated,
incorrect use of methods

The Golden minute

The first minute after birth
Anxiety for parents, health providers
Period of transition from intrauterine to
extra uterine life
Major: No/minimal assistance
10%: assistance to begin breathing at birth
1%: extensive resuscitative measures
First Golden Minute Project: skill
based training

Successful NNR: factors

Anticipation: call a skilled personnel

Adequate preparation
Accurate evaluation, algorithm based
Prompt initiation of support

Resuscitation: initial steps

Provide warmth
Head position sniffing position
Clearing the airway
Drying the baby
Tactile stimulation for breathing

Sniffing position

Extension of neck with help shoulder roll:: to

open the airway

Newly born infant

Specifically the Infant at time of birth
(A)Do not require resuscitation
(B)Require resuscitation
Rapid assessment of 3 characters
Term gestation?
Crying or breathing?
Good muscle tone?

Newly born infant

Term gestation?
Crying or breathing?
Good muscle tone?

YES :Do not require resuscitation

Dry
Skin to skin contact
Covered with dry linen to maintain
temperature
Ongoing observation: breathing, color,
activity

Newly born infant

Term gestation?
Crying or breathing?
Good muscle tone?

NO :require resuscitation; One/more

of the following actions in sequence
Initial steps in stabilization(warmth,
clear airway, dry, stimulate)
Ventilation
Chest compressions
Administration of epinephrine& /or
volume expansion

AAP
Algorithm

IAP
Algorithm

The golden minute

<30 seconds: complete initial steps

Warmth
Drying
Clear airway if necessary
Stimulate

30-60 seconds: assess 2 vital

characteristics
Respiration
(apnea/gasping/labored/unlabored)
Heart rate (<100/>100bpm)

<60 seconds of birth

If gasping/apnea
If heart rate<100 beats per minute
PPV( positive pressure ventilation)
Spo2 monitoring by pulse oximeter
Simultaneous evaluation of 3 vitals
Heart Rate,
Respiration,
oxygenation status

Targeted SPO2 after birth

1 minute

60-65%

2 minutes

65-70%

3 minutes

70-75%

4 minutes

75-80%

5 minutes

80-85%

10 minutes

85-90%

Increase in heart rate is the

most sensitive indicator of a
successful response to each
step practiced

PPV: Positive pressure

ventilation
Form of assisted ventilation
Needed when there is no
improvement in HR
Also assess chest wall movements
Should be delivered at rate of 40-60
breaths /min, maintain HR>100 /min
Devices: BMV, ET (endotracheal
tube),LMA(laryngeal mask airway)

Bag & mask ventilation

Endotracheal tube
Initial endotracheal suctioning of non
vigorous meconium stained newborn
If BMV is ineffective/prolonged
When chest compressions are
performed

Endotracheal tube

LMA(Laryngeal mask
airway)
Fits over laryngeal inlet
Done when BMV is unsuccessful
When tracheal intubation is
unsuccessful or not feasible

LMA(Laryngeal mask
airway)

Chest compressions
Started when HR<60 per minute despite
adequate ventilation with 100% oxygen for 30
sec
Delivered at lower third of sternum, to depth
1/3 of AP diameter of chest
2 techniques:
2 thumb-encircling hands technique
Compression with 2 fingers ,second hand
supporting the back
3:1 ratio::[ 90 comp:30 ventilations]

Chest compressions

medications
Rarely indicated
Most important step to treat
bradycardia is establishing adequate
ventilation
HR remains <60bpm,despite adequate
ventilation(ET) with 100% Oxygen &
chest compressions
Epinephrine or volume expansion or
both

Epinephrine
Route of administration:
intravenous(IV),ideal
Recommended dose: 0.01-0.03
mg/kg per dose
Desired concentration: 1:10,000
0.1 mg/ml

Volume expansion

Suspected or known blood loss

Isotonic crystalloid solution
Blood
Dose calculation: 10 ml/kg

Post resuscitation care

Needed for those who required PPV

At risk of deterioration
Need monitoring ,evaluation
NICU may be necessary

NNR : not indicated

Conditions with certainly early death

Extreme prematurity(GA<23 weeks)
Birth weight<400g
Anencephaly
Chromosomal abnormality: Trisomy
13

NNR: nearly always

indicated

High rate of survival

Acceptable morbidity
GA 25 weeks
Those with most congenital
malformations

NNR?
Conditions associated with uncertain
prognosis
Survival borderline
Parental desires concerning initiation
of resuscitation should be supported

Discontinuing resuscitative
efforts
Newly born baby with no detectable
heart rate, consider stopping NNR if
the heart rate remains undetectable
for 10 minutes

MCQ1
For successful neonatal resuscitation
following is/are needed except:
1.Anticipation
2.Adequate preparation
3.Skilled personnel
4.Delayed initiation of support

MCQ1
For successful neonatal resuscitation
following is/are needed except:
1.Anticipation
2.Adequate preparation
3.Skilled personnel
4.Delayed initiation of support

MCQ2
Following are true in relation to initial
steps of neonatal resuscitation
except
1.Provide warmth
2.Tactile stimulation
3.Clear airway and intubation
4.Drying the baby

MCQ2
Following are true in relation to initial
steps of neonatal resuscitation
except
1.Provide warmth
2.Tactile stimulation
3.Clear airway and intubation
4.Drying the baby

MCQ3
The following is the primary measure
of adequate ventilation
1.Chest wall movement
2.Improvement in heart rate
3.Pink extremities
4.Spo2 of 80%

MCQ3
The following is the primary measure
of adequate ventilation
1.Chest wall movement
2.Improvement in heart rate
3.Pink extremities
4.Spo2 of 80%

MCQ4
Endotracheal intubation may be
indicated at several points during
neonatal resuscitation except
1.If BMV is ineffective
2.When chest compressions are performed
3.Endotracheal suctioning of vigorous
meconium stained newborns
4.For special resuscitation circumstances like
extremely LBW

MCQ4
Endotracheal intubation may be
indicated at several points during
neonatal resuscitation except
1.If BMV is ineffective
2.When chest compressions are performed
3.Endotracheal suctioning of vigorous
meconium stained newborns
4.For special resuscitation circumstances like
extremely LBW

MCQ5
The recommended compression to
ventilation ratio in neonatal
resuscitation is
1.2:1
2.3:1
3.4:1
4.5:1

MCQ5
The recommended compression to
ventilation ratio in neonatal
resuscitation is
1.2:1
2.3:1
3.4:1
4.5:1

MCQ6
The recommended dose(mg/kg per
dose) and route of epinephrine in
neonatal resuscitation
1.0.01-0.03,IV
2.0.01-0.03,IM
3.0.03-0.05,1V
4.0.05-0.1,IV

MCQ6
The recommended dose(mg/kg per
dose) and route of epinephrine in
neonatal resuscitation is
1.0.01-0.03,IV
2.0.01-0.03,IM
3.0.03-0.05,1V
4.0.05-0.1,IV

MCQ7
Recommended method/clinical
indicator of confirming ET placement
is
1.Condensation in ET
2.Chest movement
3.Equal breath sounds on auscultation
4.Exhaled C02 Detection

MCQ7
Recommended method/clinical
indicator of confirming ET placement
is
1.Condensation in ET
2.Chest movement
3.Equal breath sounds on auscultation
4.Exhaled C02 Detection