Lesson 2 INITIAL STEPS IN RESUSCITATION Neonatal Resuscitation

Lesson 2: INITIAL STEPS IN RESUSCITATION Neonatal Resuscitation Program Slide Presentation Kit

Initial Steps Lesson content: • Decide if resuscitation is needed • Open airway and provide initial steps • Manage if meconium present • Provide free-flow oxygen when needed 2

Evaluating the Newborn Immediately after birth, the following questions must be asked: 3

Initial Steps • • • Provide warmth Position; clear airway (as necessary) Dry, stimulate, reposition 4

Initial Steps: Meconium Present • Newborn is not vigorous: Suction the baby’s trachea before proceeding with any other steps • Newborn is vigorous: Suction the mouth and nose only, and proceed with resuscitation as required 5

Provide Warmth Prevent heat loss by • Placing newborn under radiant warmer • Drying thoroughly • Removing wet towels 6

Opening the Airway Open the airway by positioning the newborn in a “sniffing” position • Positioning on back or side, slightly extending neck • “Sniffing” position aligns posterior pharynx, larynx, and trachea 7

Opening the Airway 8

Management of Meconium 9

Meconium Present and Newborn Vigorous If • • • Respiratory effort strong, and Muscle tone good, and Heart rate greater than 100 beats per minute (bpm) Then • Use bulb syringe or large-bore suction catheter to clear mouth and nose 10

Meconium Present and Newborn Not Vigorous Tracheal Suction • Administer oxygen, monitor heart rate • Insert laryngoscope, use 12 F or 14 F suction catheter to clear mouth • Insert endotracheal tube into trachea • Attach endotracheal tube to suction source • Apply suction as tube is withdrawn • Repeat as necessary 11

Suctioning Meconium Click on the image to play video 12

Clear Airway: No Meconium Present • Suction mouth first, then nose • “M” before “N” Click on the image to play video 13

Dry, Stimulate to Breathe, Reposition Click on the image to play video 14

Tactile Stimulation Click on the image to play video 15

Potentially Hazardous Forms of Stimulation • • • Slapping back or buttocks Squeezing rib cage Forcing thighs onto abdomen Dilating anal sphincter Hot or cold compresses or baths Shaking 16

Evaluation: Respirations, Heart Rate, Color Decisions and actions during newborn resuscitation are based on Respirations, Heart Rate, and Color Click on the image to play video 17

Central Cyanosis and Acrocyanosis 18

Free-flow Oxygen • Free-flow oxygen is indicated for central cyanosis • Free-flow oxygen cannot be given reliably by a mask attached to a selfinflating bag • Flow-inflating bag and mask • Oxygen tubing • Oxygen mask 19

Delivering Free-flow Oxygen • Heated and humidified (if given for longer than few minutes) • Flow rate at approximately 5 L/min • Enough oxygen for newborn to become pink 20

Evaluation: Persistent Cyanosis, Apnea, or Heart Rate <100 Continued use of tactile stimulation in an apneic newborn wastes valuable time. For persistent apnea, begin positivepressure ventilation promptly 21

End of Lesson 2

Free-Flow Oxygen Given Via Flow-Inflating Bag and Mask 2 -19 A

Free-Flow Oxygen Given Via Oxygen Tubing 2 -19 B

Free–Flow Oxygen Given Via Oxygen Mask 2 -19 C