The Fundamentals of Neonatal Resuscitation The Fundamentals of ...

9/17/2012
The Fundamentals of
Neonatal Resuscitation
Kimberly Marcus BSN,RN
REMSA Education Center RF,TF
Newborn Period Defined
• Ideally, newborn resuscitation takes
place at birth or in the NICU setting.
• Exact definition of the newborn
period “ birth to 28 days of life “.
• NRP vs. PALS
Initial Basic Assessment
• All newborns require initial assessment.
• A basic assessment can be handled promptly and quickly
with a few simple questions.
• Is the baby term Amniotic fluid clear Baby breathing or
crying Is there good muscle tone
• Hx
• Simultaneously….. basic newborn care (the infamous
inverted triangle )
• Provide warmth, position & open the airway, dry and
stimulate to breath
• Clear (if required )
Make it simple on
yourself
• Don’t STRESS out! Only about 10% of
babies need further resuscitation
• Okay we always get the other 10% so
STRESS out!
• The rest make it simple on yourself…
decide – supplemental O2, assist vent
• And it is always good to stay up on your
NRP class
Time Frame
• Remember everything in NRP is ideally
based on assessment, treat the
assessment, reevaluate the treatment
• The time frame is all done in blocks of 30
seconds
• Give yourself the full time especially when
ventilating a baby
The Bottom Line
• If you have a newborn that is Term, hx, breathing
or crying, with good tone ….GREAT routine
newborn care!
• Remember even with meconium if vigorous only
clear oro/nasal if need and give routine care.
• Vigorous/Non-vigorous
• Continue ongoing evals
• We will discuss the further needs babies in the
ABC’s
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Basic Airway
• Ideally the term newborn needs to initiate a smooth
transition out of utero and make quick effective first
breaths.
• Thus some of the changes in 2010 to help decrease delay of
breaths.
• Or the newborn needs to be effectively breathing on his
own.
• So ask yourself Are they breathing, crying, moving,
meconium but vigorous
• Then you can do simple basic airway management
Airway Management
• Support the head
• Open the airway by positioning the
newborn
• Positioning….
• Clear the airway if needed
• Meconium vigorous
• Do not delay …..WARM & DRY
Meconium
• Vigorous/Non vigorous
• Non vigorous suction trachea before
other resuscitation steps
• HR dictates time of suction
• Clear proceed
• Remember 30 second blocks!
Breathing
• The baby effectively breathing on
his own is the key to transition
• Thus “adequate ventilation” of the
baby’s lungs is the MOST important
and effective action in neonatal
resuscitation
The Good
Sooooo…..
Breathing
The Good
Warm & Dry
Airway Open
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The Bad
The Bad
HR >100
Warm & Dry
BUT
• Labored
breathing
• Cyanotic
• GIVE SUPP O2
HR

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Ratio
• 3:1 with effective ventilation
• Repeat “ One and Two and Three and
BREATHE” over 2 seconds
• 120 “events” p/min
• Anticipate… remember that hx
Drugs
• Despite 30 seconds of effective ppv, & 30
seconds of chest compressions, and the
HR < 60
• EPI
• 0.1mL/kg -0.3mL/kg IV
• Remember that Hx
• Isotonic crystalloid 10mL/kg over 5-10 min
2010 NRP Major
Recommendation Updates
• Progression to the next step after the initial eval is now
based on 2 vital characteristics .. HR & RESPIRATIONS
• Titrate oxygen with oximetry color subjective
• Babies born at term best to begin resuscitation with RA and
move forward.
• Admin of supplemental O2 should be blended if capable
• Research does not support or refute routine sxn
• Chest compression-vent ratio 3:1 unless known cardiac origin
• Consideration of therapeutic hypothermia for term/near
term infants with moderate to severe hypoxic ischemic
encephalopathy
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