NEONATE RESUSCITATION
PREPARE to resuscitate the newborn at every birth (Respiratory focused Resus)
30s for adequate stimulation (dry head) Key Notes:
Is baby dead? – if so were they dead in utero or post -delivery? *Minimise oxygen ® acts as
drug ® ROS production –
Assess HR/RR using pulsation of umbilical cord cytotoxic – brain/organ damage
NO HR > BAD RESUS = HIE = CP!
Crying HR present
Regular RR Irregular/ no RR
(GASPING/APNOEA) • Call code blue
• CPR 3:1
• High FiO2 (100% O2)
30 s ventilation (ROOM AIR) • Adrenaline 0.1mL/kg (1:10000)
Monitor • Airways positioned in for 1 min then 2nd cycle
(check BSL) NEUTRAL position • ADMINISTER VIA UMBO VEIN
Mother skin-skin • 30 bpm
HR > 60 HR < 60
SIGNS OF GOOD VENTILATION
1. CHEST Movement
2. Increase HR 30s ventilation Start CPR
3. Improved Sats + Reduced CONSIDER ANATOMICAL CAUSES:
WOB and RR (if ventilation + CPR given)
Crying & Regular RR Check equipment (from pt to wall)
If NOT improved?
• M: mask tightly fit? A/B:
Post resus care: • R: Reposition head into Ø Upper airway (obstruction,
sniffing position congenital airway anomalies)
• S: Safe care and sugar
• S: suction nares and pharynx Ø Lower airway (severe hMD,
• T: Temp. (plastic bag, overhead
heater) • O: Open mouth + oxygen pulm. Hypoplasia, PHTN)
• P: PPV – ensure adequate Ø External: PTX, pleural effusion,
• A: Airway
flow 8L/min ascites, CDH
• B: BP
• A: Alternate airway adjunct C – Congenital HB, cyanotic CHD
• L: Lab work (LMA, I+V)
• E: Emotional support (families & D - maternal meds, brain injury,
staff) encephalopathy, sepsis, NMD
Epidemiology Post-resus care: Physiology of ASPHYXIA (Brain Hypoperfusion)
Hypoglycaemia
• 85% ® initiate Ø
o 10% dextrose or glucogel
resp. spontaneously (0.5mL/kg)
• 10% ® initiate Ø Hypovolaemia
o 0.9% NS 10mL/kg
resp. while drying
Ø Infection
• 3% ® CPAP o BenPen (+)
o Gent (-)
• 2% ® vent. Support Ø Lung maturation
Artificial surfactant
• 0.1% ® CPR + o
o NGT (meconium aspirate)
adrenaline
ARDS CAUSES
RESP NON-RESP
TTN Sepsis
Pneumonia Metabolic acidosis
PTX Anaemia
Meconium aspiration syndrome HIE
Persistent PHT Congenital HD
TOF
Congenital diaphragmatic hernia
, Resp-focused neonate resuscitation:
Turn on Neopuff + prepare resus trolley è light and heater on è ensure ventilation working
• Check T-piece
• Check CPAP pressure – adjustable (lower for pre-term)
Check ante-natal notes:
Antepartum: Intrapartum: Important Q’s to ask: Before delivery:
Prep • Pre-eclampsia • Emergency LSCS Ø Meconium in liquor Ø Delivery method
• GDM • Prem labour Ø PV bleeding or blood-stained Ø GxPy + ABO (anti-D)
• Multiple pregnancy • Chorioamnionitis liquor Ø Infection status (BBV, TORCH, STI)
• Oligo/poly hydramnios • Placental abruption Ø Maternal issues Ø Abnormal ante-natal scans or tests
• Reduced fetal movement • Placental praevia Ø Foetal issues Ø Substance abuse
• Substance use Ø Vit K (IVH &haemorrhagic bleed of newborn)
• Check drips, sharps, remove furniture
D
• Provide stimulation + warmth + dry baby using plastic bag
Rs • Send for Help EARLY & Grab paeds resus trolley è “code-blue” + call “2222”
POSITION: Suction: Adjuncts
• Slightly extend neck • Aspiration meconium • Oropharyngeal Guedel (incisor to angle of jaw)
A • chin lift
è
• [NOT needed]
è
• Laryngeal mask (only for >34 wks GA or ETT
• jaw thrust unsuccessful)
• Check RR/HR • BEGIN PPV (bag-valve + Neopuff) Commence “oxygen” if:
• RESP: Apnoea > 30s o Set ROOM AIR + rate 40-60/min • Infant needs cardiac massage
WoB: o 25/6 cmH20 (IPPV, PEEP/CPAP) • No improvement after ventilation (i..e
• Chest wall movement o 30/6 (If HR < 100) bradycardic + intercostal recession + apnoea)
• Tracheal tug • ALL ABOUT BAGGING WELL • ETT (skill dependent) used ONLY if:
B • Grunting è • Correct paediatric mask fit (ensure you see
chest rise and fall)
è o
o
No heartbeat heard
Ineffective PPV
• Assisted ventilation of a baby’s lungs is the o To administer adrenaline
MOST effective action to resuscitating a o Suspected congenital
compromised infant diaphragmatic hernia
C
• Apply ECG & SaO2 (RIGHT HAND as pre-ductal) esp. if there is PDA HR Action Stop compressions +
• CPR è After 2 effective rescue breaths in lifeless infant No action Stop PPV ® APGAR score 1, 5
o Pulse check ® femoral + brachial ONLY for infants >100
(aim 120bpm) and 10 min
• Neonate 3:1 (3 compressions to 1 breath))
60-100 Continue PPV Continue PPV
• Infant 15:2 breaths (best = thumbs) è 100-120 bpm (1/3rd depth)
Start CPR + PPV + Intubate + adrenaline (via ETT
<60
FiO2 100% or UVC)
• Defibrillated (place pads + perform rhythm check) = if in shockable rhythm (VF, VT)
o COACHED ® deliver shock at 4J/kg
Defib o Recommence compressions after shock delivered
o When sinus rhythm returned or PEA® check for pulse
• Disarm machine = if non-shockable rhythm
Oxygen MoA INDICATION Route
Adrenaline (1:10000) • ↑ CO + HR = ↑ MAP • HR < 60 after effective CPR, PPV, FIO2 • Umbilical vein (best)
• Vasoconstrict = ↑TPR • Repeat dose every 3-5 mins @ 0.1-0.3 mL/kg
Vasodilators • ↑ vascular vol. • HR not increasing • Umbilical vein (best) 10mL/kg over
Drugs (Normal NaCl & O neg • ↓met acidosis by increasing • Blood loss suspected (pallor, weak pulse, 5-10 mins
blood) tissue perfusion poor perfusion)
*ADMINISTER MEDICATIONS VIA umbilical vein ® into umbilical vein (biggest collapsible thin walled vein)
Ø If UVC catheter wanted ® confirm position in IVC via AXR (should be at T10 level)
o Should not be in T12 (renal vein)
Debrief Document When to stop
• Parents • Tone, breathing, HR & HCW involved • Depends on infant E.g. In infants with an Apgar 0 after
• Delivery room staff (Nurses, • Time/details of intervention: 10mins of resuscitation, if the HR is undetectable, it may
obstetrician, anaesthetist) When Ventilation + CPR be reasonable to stop assisted ventilation.
After ―
• NICU staff (if baby going there for commenced • APGAR (1 after 1 min) = due to low HR ® signs of acidosis
math further management) ― Drugs given (route?) + ↑ lactate ® resp. compensation to blow out CO2
• NETS (if baby to be transferred) ― Vital signs (incl. post-resus Obs) • APGAR (8 after 5 mins) ® lost in activity and colour
*May need interpreter ― Agpar score
• Management plans
PREPARE to resuscitate the newborn at every birth (Respiratory focused Resus)
30s for adequate stimulation (dry head) Key Notes:
Is baby dead? – if so were they dead in utero or post -delivery? *Minimise oxygen ® acts as
drug ® ROS production –
Assess HR/RR using pulsation of umbilical cord cytotoxic – brain/organ damage
NO HR > BAD RESUS = HIE = CP!
Crying HR present
Regular RR Irregular/ no RR
(GASPING/APNOEA) • Call code blue
• CPR 3:1
• High FiO2 (100% O2)
30 s ventilation (ROOM AIR) • Adrenaline 0.1mL/kg (1:10000)
Monitor • Airways positioned in for 1 min then 2nd cycle
(check BSL) NEUTRAL position • ADMINISTER VIA UMBO VEIN
Mother skin-skin • 30 bpm
HR > 60 HR < 60
SIGNS OF GOOD VENTILATION
1. CHEST Movement
2. Increase HR 30s ventilation Start CPR
3. Improved Sats + Reduced CONSIDER ANATOMICAL CAUSES:
WOB and RR (if ventilation + CPR given)
Crying & Regular RR Check equipment (from pt to wall)
If NOT improved?
• M: mask tightly fit? A/B:
Post resus care: • R: Reposition head into Ø Upper airway (obstruction,
sniffing position congenital airway anomalies)
• S: Safe care and sugar
• S: suction nares and pharynx Ø Lower airway (severe hMD,
• T: Temp. (plastic bag, overhead
heater) • O: Open mouth + oxygen pulm. Hypoplasia, PHTN)
• P: PPV – ensure adequate Ø External: PTX, pleural effusion,
• A: Airway
flow 8L/min ascites, CDH
• B: BP
• A: Alternate airway adjunct C – Congenital HB, cyanotic CHD
• L: Lab work (LMA, I+V)
• E: Emotional support (families & D - maternal meds, brain injury,
staff) encephalopathy, sepsis, NMD
Epidemiology Post-resus care: Physiology of ASPHYXIA (Brain Hypoperfusion)
Hypoglycaemia
• 85% ® initiate Ø
o 10% dextrose or glucogel
resp. spontaneously (0.5mL/kg)
• 10% ® initiate Ø Hypovolaemia
o 0.9% NS 10mL/kg
resp. while drying
Ø Infection
• 3% ® CPAP o BenPen (+)
o Gent (-)
• 2% ® vent. Support Ø Lung maturation
Artificial surfactant
• 0.1% ® CPR + o
o NGT (meconium aspirate)
adrenaline
ARDS CAUSES
RESP NON-RESP
TTN Sepsis
Pneumonia Metabolic acidosis
PTX Anaemia
Meconium aspiration syndrome HIE
Persistent PHT Congenital HD
TOF
Congenital diaphragmatic hernia
, Resp-focused neonate resuscitation:
Turn on Neopuff + prepare resus trolley è light and heater on è ensure ventilation working
• Check T-piece
• Check CPAP pressure – adjustable (lower for pre-term)
Check ante-natal notes:
Antepartum: Intrapartum: Important Q’s to ask: Before delivery:
Prep • Pre-eclampsia • Emergency LSCS Ø Meconium in liquor Ø Delivery method
• GDM • Prem labour Ø PV bleeding or blood-stained Ø GxPy + ABO (anti-D)
• Multiple pregnancy • Chorioamnionitis liquor Ø Infection status (BBV, TORCH, STI)
• Oligo/poly hydramnios • Placental abruption Ø Maternal issues Ø Abnormal ante-natal scans or tests
• Reduced fetal movement • Placental praevia Ø Foetal issues Ø Substance abuse
• Substance use Ø Vit K (IVH &haemorrhagic bleed of newborn)
• Check drips, sharps, remove furniture
D
• Provide stimulation + warmth + dry baby using plastic bag
Rs • Send for Help EARLY & Grab paeds resus trolley è “code-blue” + call “2222”
POSITION: Suction: Adjuncts
• Slightly extend neck • Aspiration meconium • Oropharyngeal Guedel (incisor to angle of jaw)
A • chin lift
è
• [NOT needed]
è
• Laryngeal mask (only for >34 wks GA or ETT
• jaw thrust unsuccessful)
• Check RR/HR • BEGIN PPV (bag-valve + Neopuff) Commence “oxygen” if:
• RESP: Apnoea > 30s o Set ROOM AIR + rate 40-60/min • Infant needs cardiac massage
WoB: o 25/6 cmH20 (IPPV, PEEP/CPAP) • No improvement after ventilation (i..e
• Chest wall movement o 30/6 (If HR < 100) bradycardic + intercostal recession + apnoea)
• Tracheal tug • ALL ABOUT BAGGING WELL • ETT (skill dependent) used ONLY if:
B • Grunting è • Correct paediatric mask fit (ensure you see
chest rise and fall)
è o
o
No heartbeat heard
Ineffective PPV
• Assisted ventilation of a baby’s lungs is the o To administer adrenaline
MOST effective action to resuscitating a o Suspected congenital
compromised infant diaphragmatic hernia
C
• Apply ECG & SaO2 (RIGHT HAND as pre-ductal) esp. if there is PDA HR Action Stop compressions +
• CPR è After 2 effective rescue breaths in lifeless infant No action Stop PPV ® APGAR score 1, 5
o Pulse check ® femoral + brachial ONLY for infants >100
(aim 120bpm) and 10 min
• Neonate 3:1 (3 compressions to 1 breath))
60-100 Continue PPV Continue PPV
• Infant 15:2 breaths (best = thumbs) è 100-120 bpm (1/3rd depth)
Start CPR + PPV + Intubate + adrenaline (via ETT
<60
FiO2 100% or UVC)
• Defibrillated (place pads + perform rhythm check) = if in shockable rhythm (VF, VT)
o COACHED ® deliver shock at 4J/kg
Defib o Recommence compressions after shock delivered
o When sinus rhythm returned or PEA® check for pulse
• Disarm machine = if non-shockable rhythm
Oxygen MoA INDICATION Route
Adrenaline (1:10000) • ↑ CO + HR = ↑ MAP • HR < 60 after effective CPR, PPV, FIO2 • Umbilical vein (best)
• Vasoconstrict = ↑TPR • Repeat dose every 3-5 mins @ 0.1-0.3 mL/kg
Vasodilators • ↑ vascular vol. • HR not increasing • Umbilical vein (best) 10mL/kg over
Drugs (Normal NaCl & O neg • ↓met acidosis by increasing • Blood loss suspected (pallor, weak pulse, 5-10 mins
blood) tissue perfusion poor perfusion)
*ADMINISTER MEDICATIONS VIA umbilical vein ® into umbilical vein (biggest collapsible thin walled vein)
Ø If UVC catheter wanted ® confirm position in IVC via AXR (should be at T10 level)
o Should not be in T12 (renal vein)
Debrief Document When to stop
• Parents • Tone, breathing, HR & HCW involved • Depends on infant E.g. In infants with an Apgar 0 after
• Delivery room staff (Nurses, • Time/details of intervention: 10mins of resuscitation, if the HR is undetectable, it may
obstetrician, anaesthetist) When Ventilation + CPR be reasonable to stop assisted ventilation.
After ―
• NICU staff (if baby going there for commenced • APGAR (1 after 1 min) = due to low HR ® signs of acidosis
math further management) ― Drugs given (route?) + ↑ lactate ® resp. compensation to blow out CO2
• NETS (if baby to be transferred) ― Vital signs (incl. post-resus Obs) • APGAR (8 after 5 mins) ® lost in activity and colour
*May need interpreter ― Agpar score
• Management plans
