Definition of "Neonatal resuscitation"
Neonatal resuscitation (aka newborn resuscitation) is the resuscitation of a newborn child with birth asphyxia.
Patient information
Neonatal means within the 1st 4 weeks of birth. So this is that?Sort of. We're particularly looking at those just born, and not getting any oxygen.
- Danger, preventing heat loss, by drying the baby
- Response, checking if the baby is breathing or crying, whether there's good tone, stimulate baby
- Send for help
- Airways, ensure open
- Breathing, check if gasping or apnea. If labored breathing or persistent cyanosis, consider CPAP. Otherwise, consider PPV (positive pressure ventilation)
- Circulation, check if <100bpm, if so, monitor. If <60bpm, start Compression, 90/min, 3:1 compressions per breath. Use 100% oxygen. Consider intubation or LMA. If still problematic, consider venous access, adrenaline, and IV fluids
Source: NSW Health
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Patient information
What do you do to help a newborn who's not getting any oxygen?DRSABC. So check for danger. Check response. Send for help. Ensure airways are open. Check breathing. Check circulation, and start compressions.
How do you check response in a bub? They can't really talk?
You check if they're breathing or crying. Check for tone. And you can stimulate bub, by drying with a soft towel.
How do you check breathing?
Look, listen, feel for breath and a rising tummy. If there is only difficult breathing or baby is blue, and no other problems, consider CPAP, which is a way to keep the airways open by air pressure. If there's no breathing, you then need to consider mechanical ventilation, where you forcefully push air into the trachea.
What do you do with circulation, and when do you start compressions?
Circulation should be >100bpm in bub. So if it's below we're suspicious. You might remember we don't do anything in adults until it drops below 60bpm, and it's the same in bub. If it drops below that, we start compressions, at 90/min. And do 3 compressions per breath.
Wait. For adults, wasn't it compress 100/min. And do 15 compressions per 2 breaths?
It's correct, but that was for adults. For kids, it's 90/min. And 3:1.
- Hypoxic damage to most of the infant's organs, including heart, lungs, liver, gut, kidneys, but brain damage is of most concern
- Depends on how quickly and successfully the infant is resuscitated
- 25% of all neonatal deaths globally are caused by birth asphyxia
- Although traditionally, resuscitation has been with mechanical ventilation with 100% oxygen, there has been increasing debate whether normal air should be used, because of concerns that high concentrations of oxygen can cause generation of oxygen free radicals, which have a role in reperfusion injury after asphyxia
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