RESUSCITAON

OF THE
NEWBORN
 Newborn Deaths
8.1 million infant deaths
3.9 million (48%)
newborn deaths
2.8 million (67%) early
newborn deaths
Major causes of newborn
deaths
Birth asphyxia: 21%
Infections: 42%
(tetanus, sepsis,
meningitis, pneumonia,
diarrhea)
 Newborn Deaths (continued)
Birth process was the antecedent cause of 2/3 of
deaths due to infections
Lack of hygiene at childbirth and during newborn
period
Home deliveries without skilled birth attendants
Birth asphyxia in developing countries
3% of newborns suffer mild to moderate birth
asphyxia
Prompt resuscitation is often not initiated or
procedure is inadequate or incorrect
Fetal Hypoxaemia >
Hypoxia > Asphyxia

Respiratory & metabolic acidosis

 birth asphyxia is defined
simply as the failure to
initiate and sustain
breathing at birth
The common worry of health
professionals and parents is the
permanent brain damage that
birth asphyxia can cause.
DISORDERS PREDISPOSING TO
ASPHYXIA AT BIRTH
Maternal Conditions
Hypertension
Toxemia
Maternal treatment with any of the
following drugs: -adrenergic drugs, ethyl
alcohol, narcotic or barbiturate abuse.
Maternal infection - chorioamnionitis.
Hemorrhage - placenta previa, abruptio
placenta
 Conditions of Labor and Delivery -

High or mid forceps extraction.

Prolonged or abnormal pattern of labor.
Breech or other abnormal presentation.
Maternal hypotension.
Prolapsed umbilical cord.
Sedative or analgesic drug given
intravenously one hour, or intramuscularly
within two hours of delivery.
 Fetal Conditions -
Second of multiple births, especially with
long delay.
Hydrops fetalis.
Prematurity or postmaturity.
Intrauterine growth retardation.
Meconium staining of amniotic fluid.
Abnormal fetal heart rate pattern.
Fetal ph < 7.2
Immature lecithin-sphingomyelin ratio.
pH is a log scale of H+
 Apgar Scoring System
Sign Score
0 1 2
Heart rate Absent <100 beats/min >100
beats/min
Respiratory Absent Slow, irregular Sustained
efforts gasps
Muscle tone Limp Some flexion of Good
extremities motion
Reflexes and No Grimace Cry
irritability response
Skin color Blue, pale Body pink, All pink
extremities blue
Diagnosis of hypoxia > Asphyxia additional methods
pH, lactate
 WHO Guidelines
Prepare for birth
two clean towels for thermal protection
a suction device ( mucus extractor)
a radiant heater (if available)
a draught-free delivery room > 25oC
clean delivery kit for cord care, gloves
two infant masks (normal)
a blanket
a clock
an additional set of equipment in reserve for multiple births or in
case of failure of the first set
inform mother
open the airway - clear the airway by suctioning first the mouth and
then the nose
ventilate with appropriate mask (size 1 for a normal weight and 0
for a small newborn)
observe the rise of the chest
ventilate 40 (30-60) breaths/min
stop an look for spontaneous breathing after about 1 min
 Management of baby
with birth asphyxia

1)Basic Resuscitation
2)Advanced Resuscitation
 ABCs of Resuscitation
A B C (A: Airway, B: Breathing, C: Circulation)
A - establish open airway
Position, suction
B - initiate breathing
Tactile stimulation
Oxygen
C - maintain circulation
Chest compressions
Medications
 Basic Resuscitation
Initial steps:
Thermal management
Positioning
Suctioning
Tactile stimulation
1.Anticipation.
2.Adequate preparation.
3.Timely recognition.
4.Quick and correct action
are critical for the success of
resuscitation
 Good management of
pregnancy and
labour/delivery
complications
is the best means of
preventing birth asphyxia
The most important is to get air into the lungs
Facts About Newborn Resuscitation
 Bag and mask

Ventilate for 30 seconds:

Rate: 40-60 /min

Pressure: Visible rise and fall of chest

HR < 60 HR 60-100 HR >100

HR > 100 bpm:

Continue ventilation
Continue ventilation Check for spontaneous
Initiate chest compression
Consider intubation respirations
Consider intubation
Bag and mask the most important tool
in newborn resuscitation
 Algorithm of resuscitation of the newborn
Baby blue and limp;
Heart rate < 100 and so on
Suction oropharynx
Stimulate; give O2 by mask
Heart rate < 60 - cardiac massage
Bag and mask inadequate - intubate
and give O2 by endotracheal tube
Insert umbilical vein catheter for
medication
Normal ultra scan of the brain of newborn
Brain edema (consequences after severe asphyxia))
Periventricular leukomalacia.
Features of brain atrophy
 Medication of the newborn
Sodium bicarbonate IV Be certain that:
2 mEq/kg (0,5 mEq/ml) Bag delivers 100% O2
Epinephrine
Endotracheal tube is in
0.1 - 0.3 ml/kg (1:10,000) trachea
Atropine 0.03 mg/kg
O2 connections are secure
5% albumin (10ml/kg)
Pressure is adequate to
or normal saline (10ml/kg)
ventilate
Epinephrine - repeat
Cardiac massage is adequate
0.5 - 1.0 ml (1:10,000)
Calcium gluconate 10% 2 ml,
slowly
 The results of an Asphyxia
Hydrocephalus, hydrocranium
Convulsive syndrome, epilepsy
Being backward in physical and mental
development (retardation of development
Cerebral paralysis, flaccid paralysis's
Cephalopathy wish syndromes:
a) of flaccidity
b) of excitability
c) of discomfort
Feeble - mindedness
Baby after severe asphyxia
Baby after moderate asphyxia
Baby after moderate asphyxia
Baby after severe asphyxia
Baby after severe asphyxia
Baby after severe asphyxia
Baby after severe asphyxia
 Principles of restoration theraphy after
severe and moderate asphyxia

Feeding according to the age of the baby

The drugs improving psychological and motor
development of child (glycinum, acidum glutaminicum,
aminalonum, piriditolum, encefabol, v. B12 and so on)
Medicines depressing the pathological activity and
stimulating the processes of regeneration (pyracetamum,
nootropil, V B1, B6, B15, mydocalm, acidum valproicum,
natrium valproicum )
Physical training, massage, water treatment
Speak - music lessons, color-therapy and so on
Thanks for attention!