Neonatal resuscitation Primary cause of death NNPD 4

Neonatal resuscitation

Primary cause of death: NNPD

4 million newborn deaths – Why? almost all are due to preventable conditions

Others: Hypothermia, RD, Jn, Pulm. Haemorrhage, Seizure etc. ICMR 2006

Neonatal resuscitation • Asphyxia accounts for 20 -25% newborn deaths • 10% neonates require some assistance at birth • 1% neonates need extensive resuscitative measures

The most important and effective action is to ventilate the baby’s lungs

Neonatal resuscitation • Airway • Breathing • Circulation

Neonatal resuscitation • Airway • Breathing • Circulation

Before birth • Gas exchange in placenta • Lung receives very little blood • Alveoli are fluid filled

Very little flow to lungs

Blood vessels are constricted Alveoli are fluid filled

Before birth • Pulm arterioles constricted • High pressure in pulmonary circuit • Umbilical arteries feeding low pressure placenta circulation • Low pressure in systemic circuit • Very little pulmonary blood flow

After birth 1. • Fluid in the alveoli is absorbed Alveoli • EXPAND • GET FILLED WITH AIR (O 2)

After birth 2. Umbilical arteries and veins are clamped Sudden increase in systemic blood pressure

Pulmonary vessels dilate, causing increased blood flow to lungs 3.

After birth • Pulm arterioles dilate • Umbilical arteries and veins are clamped • Low pressure in pulmonary circuit • High pressure in systemic circuit • Dramatic increase in pulmonary blood flow

Ductus arteriosus constricts 4. • Increased oxygen in blood • Increased pulmonary blood flow

Before After

What can go wrong • Inadequate breathing hence lung fluid not absorbed • Meconium may block airway • Blood loss may occur • Persistence of constricted pulmonary vessels • Myocardium may be depressed • Organ systems may be affected by hypoxia/ischemia

Consequences of interrupted transition 1. 2. 3. 4. 5. 6. Low muscle tone Resp depression (apnea / gasping) Tachypnea Bradycardia Hypotension Cyanosis

Changes due to oxygen deprivation

Some dictums If a baby does not breathe immediately after being stimulated >>> secondary apnea Assume every apneic baby is in secondary apnea Longer the duration of compromise, longer it takes for recovery

• The resuscitation flow diagram *

Evaluation-Decision-Action cycle Evaluation Action Decision

Evaluation: By 3 signs 1. Respiration • • Breathing / crying Apnea 2. Heart rate • • <100 or not < 60 or not 3. Color • • Central cyanosis Peripheral cyanosis / pink

ent m s s Asse • The resuscitation flow diagram lu Eva ation lua Eva * lu Eva ation

Apgar score

Apgar score is great, but not for guiding resuscitation • For resuscitation, not all items are required • Resuscitation initiated before 1 min when Apgar is assigned • Classification different

Requirements • Personnel – At least one trained person for all deliveries – Two persons, if high risk; or for advanced resuscitation • Equipment

Risk factors of asphyxia • Only 50% resuscitation needs are identified prior to birth

Premature babies : concerns 1. May be surfactant deficient 2. Immature brain, poor resp drive 3. Weak muscles, not able to breathe 4. More prone to hypothermia 5. More likely to be infected 6. Prone to intraventricular hemorrhage 7. Small blood volume, prone to hypovolemia 8. Immature tissues, prone to oxygen toxicity

Care after resuscitation *

Prevent, prevent Infection : asepsis HIV : universal precautions