RESUSCITATION. If baby very floppy and heart rate slow, assist breathing immediately. If baby not breathing adequately by 90 sec, assist breathing

Size: px

Start display at page:

Download "RESUSCITATION. If baby very floppy and heart rate slow, assist breathing immediately. If baby not breathing adequately by 90 sec, assist breathing"

Marshall Byrd
5 years ago
Views:

1 RESUSCITATION Check equipment daily, and before resuscitation Follow Resuscitation Council UK Guidelines DRY AND COVER Cord clamping see Cord clamping below >28 weeks gestation, dry baby, remove wet towels and cover baby with dry towels <28 weeks gestation, do not dry body but place in plastic bag, dry head only and put on hat Cord clamping It is current NLS recommendation that cord is not clamped immediately In uncompromised infants a delay in cord clamping of at least one minute is recommended After discussion in Staffordshire, Shropshire & Black Country resuscitation group it has been decided any time a neonatologist is called for fetal reasons, do not delay cord clamping ASSESS Assess colour, tone, breathing and heart rate If baby very floppy and heart rate slow, assist breathing immediately Reassess every 30 sec throughout resuscitation process If help required, request immediately CHECK AIRWAY If baby not breathing adequately by 90 sec, assist breathing For baby to breathe effectively, airway must be open To open airway, place baby supine with head in neutral position If very floppy, consider chin support or jaw thrust while maintaining the neutral position IMMEDIATE TREATMENT Airway Keep head in neutral position Use T-piece and soft round face mask, extending from nasal bridge to chin Give 5 inflation breaths, sustaining inflation pressure (Table 1) for 2 3 sec for each breath Give PEEP of 5 cm H 2 O Begin inflation breaths in air Table 1: Inflation pressure (avoid using pressure higher than recommended) Term infant 30 cm of water Preterm infant cm of water No chest movement Ask yourself: Is head in neutral position? Is a jaw thrust required? Do you need a second person to help with airway to perform a jaw thrust?

2 Is there an obstruction and do you need to look with a laryngoscope and suck with a largebore device? Consider placing oro-pharyngeal (Guedel) airway under direct vision using laryngoscope Is inflation time long enough? if no chest movement occurs after alternative airway procedures above have been tried (volume given is a function of time and pressure), a larger volume can be delivered if necessary by inflating for a longer time (3 4 sec) Attach saturation monitor to right hand see Saturation monitoring for guidance on saturation targets Endotracheal intubation Indications Severe hypoxia (e.g. terminal apnoea or fresh stillbirth) Stabilisation of airway Extreme prematurity Congenital diaphragmatic hernia Safe insertion of tracheal tube requires skill and experience If you cannot insert a tracheal tube within 30 sec, revert to mask ventilation Breathing Most babies have a good heart rate after birth and establish breathing by 90 sec if not breathing adequately give 5 inflation breaths, preferably using air at pressures in Table 1 heart rate should rapidly increase as oxygenated blood reaches heart Do not move onto ventilation breaths unless you have a heart rate response OR you have seen chest movement Review assessment after inflation breaths Is there a rise in heart rate? Is there chest movement with the breaths you are giving? If no spontaneous breathing, but chest movement has been obtained, perform 30 sec of ventilation breaths, given at a rate of 30 breaths per min (1 sec inspiration) Table 2: Outcome after 30 sec of ventilation breaths Heart rate Breathing Action Increases Not started breathing Provide breaths/min Where available, use PEEP at 5 cm water with T-piece system <60 Obvious chest movement Start chest compressions See below If baby is floppy with slow heart rate and there is chest movement, start cardiac compressions with ventilation breaths immediately after inflation breaths Increase inspired oxygen concentration every 30 sec by 30% e.g % depending on response see Saturation chart

3 Chest compression Use if heart rate approximately <60 beats/min (do not try and count accurately as this will waste time) Figure 1 Figure 2 Start chest compression only after successful inflation of lungs Pictures taken from NLS manual and Resuscitation Council (UK) and reproduced with their permission Ideal hold (figure1/figure 2) Circle chest with both hands so that thumbs of both hands can press on the sternum just below an imaginary line joining the nipples with fingers over baby s spine Alternative hold (less effective) Compress lower sternum with fingers whilst supporting baby s back. The alternative hand position for cardiac compressions can be used when access to the umbilicus for UVC catheterisation is required, as hands around the chest may be awkward

4 Action Compress chest quickly and firmly to reduce the antero-posterior diameter of the chest by about one-third, followed by full re-expansion to allow ventricles to refill remember to relax grip during IPPV, and feel for chest movement during ventilation breaths, as it is easy to lose neutral position when cardiac compressions are started Co-ordinate compression and ventilation to avoid competition. Aim for 3:1 ratio of compressions to ventilations, and 90 compressions and 30 breaths (120 events ) per min Blood If there is evidence of fetal haemorrhage, consider giving O negative emergency blood Resuscitation drugs Always ask about drugs taken recently by, or given to mother Consider drugs only if there is an undetectable or slow heartbeat despite effective lung inflation and effective chest compression Umbilical venous catheter (UVC) preferred venous access Adrenaline 1:10, microgram/kg (0.1 ml/kg) IV If this dose is not effective, consider giving 30 microgram/kg (0.3 ml/kg) after sodium bicarbonate has been given Adrenaline should only be given via the ET tube if venous access is taking time to achieve; it should not delay intravenous access and treatment; the dose is ml/kg of 1 in 10,000. Sodium bicarbonate 4.2% 1 2 mmol/kg (2 4 ml/kg) IV (never give via ET tube) Glucose 10% 2.5 ml/kg IV slowly over 5 min Sodium chloride 0.9% 10 ml/kg IV Naloxone Consider only after ventilation by mask or endotracheal tube has been established with chest movement seen and heart beat >100 beats/min If mother has been given pethidine within 2 4 hr of delivery, give IM naloxone: 100 microgram (0.25 ml) for small prem babies 200 microgram (0.5 ml) for all other babies Do not give naloxone to babies born to mothers who abuse narcotics WHEN TO STOP If no sign of life present after 10 min of continuous good quality resuscitation, outlook is poor with few survivors, majority will have cerebral palsy and learning difficulties If no sustained spontaneous breathing 30 min after a heart rate has been established, majority also have poor prognosis Continue resuscitation until a senior neonatologist advises stopping

5 MONITORING Saturation monitoring Oxygen monitoring is activated when paediatrician/2 nd pair of hands arrives. In the meantime, the person initiating resuscitation carries out all the usual steps in resuscitation Do not stop resuscitation for a saturation probe to be attached Attach saturation monitor to the right hand once five inflation breaths have been given Saturations should spontaneously improve as Table 3 Table 3 Time (min) Acceptable pre-ductal saturations (%) Air to oxygen If inflation breaths have been successful and chest movement seen but heart rate and/or colour/saturations (if available) not improved: in term babies increase oxygen to 30% in preterm babies increase oxygen to 30% If no response, increase by increments of 30% every 30 sec i.e.: Term air /100% Preterm air /100% Reduce oxygen if saturation levels as per Boost recommendations when oxygen saturation levels at 91 95% for preterm <30 weeks or >95% for term at 10 min of life (otherwise Resus Council target sats should be followed to stop babies being too pink too early on and being at risk of O 2 toxicity) Preterm deliveries >26 weeks gestation do not require routine intubation if respiratory effort good these babies can receive PEEP 5cm H 2 0 via mask ventilation with oxygen supplementation as appropriate on the resuscitaire and PEEP support on transfer to NICU If respiratory effort is poor, at any point, or baby s condition deteriorates, intubate and ventilate as per BAPM guidance DOCUMENTATION Make accurate written record of facts (not opinions) as soon as possible after the event Record when you were called, by whom and why condition of baby on arrival what you did and when you did it timing and detail of any response by baby date and time of writing your entry a legible signature COMMUNICATION Inform parents what has happened (the facts)

6 Newborn life support algorithm Dry baby Remove wet towels and cover Start clock or note time Birth AT Assess tone, breathing and heart rate If gasping or not breathing Open airway Give 5 inflation breaths Consider SpO 2 monitoring 30 sec 60 sec ALL STAGES Re-assess If no increase in heart rate, look for chest movement ASK: If chest not moving Re-check head position Consider 2-person airway control and other airway manoeuvres Repeat inflation breaths Consider SpO 2 monitoring Look for a response Acceptable Pre-ductal SpO 2 2 min 60% 3 min 70% 4 min 80% 5 min 85% 10 min 90% No increase in heart rate Look for chest movement When chest moving If heart rate not detectable or slow (<60/min), start chest compressions 3 compressions to each breath DO YOU Re-assess heart rate Every 30 sec If heart rate not detectable or slow (<60/min), consider venous access and drugs NEED HELP?

Learning objectives. First Response Learning Module 2 Based on ILCOR and ANZCOR 2016

Learning objectives. First Response Learning Module 2 Based on ILCOR and ANZCOR 2016 First Response Learning Module 2 Based on ILCOR and ANZCOR 2016 Learning objectives Following completion of the theoretical & practical components of this module, the participant will be able to demonstrate