NEONATAL RESUSCITATION

Rachel Musoke University of Nairobi KNH/UON SYMPOSIUM 10TH Jan 2013

Poor intrapartum fetal oxygenation

Also referred as asphyxia Common cause of death & long term disability (mental & neurological) Estimated to contribute to 9% of all < 5 mortality (MDG 4) Burden of disease assessment 42 million disability-adjusted life years (DALYs)

Contributing factors
The delays Delay in recognition of the problem in the mother Delay in transportation to a medical facility Delay in providing appropriate care at the health facility

Solutions to reduce deaths & disability

Primary prevention maternal care (early recognition & management) Secondary prevention appropriate neonatal resuscitation Tertiary prevention recognition & management of acute complications

The Global Need for neonatal Resuscitation, FIGO, Wall et al

Which babies need resuscitation?

Assess: Gestation term or preterm? Breathing or Crying? Good tone? If NO then act quickly

The first golden minute

The ABC of resuscitation

Airway (Position and clear) Breathing (stimulate to breathe) Circulation (Majority of babies have normal hearts)

Warmth

Breathing

Ventilation of babys lungs is the most important and effective action in neonatal resuscitation

Room air vs.O2 for Resuscitation

Term Infants

Pre-Term Infants (< 32 weeks)

Room air or oxygen?

Term infants:
Mortality lower with room air vs 100% O2 Shorter recovery

Preterm Balance the needs for oxygen vs possible toxicity

Oxygen saturations at birth

1 minute 2 minutes 3 minutes 60-65% 65-70% 70-75%

4 minutes
5 minutes 10 minutes

75-80%
80-85% 85-95%

Meconium stained liquor

Clear mouth & nose before drying & stimulation to avoid aspiration
Suctioning of the trachea reserved for nonvigorous babies

Equipments
Warmth towels & heater Airway suction catheters Ventilate bag (500ml). & masks (sizes) Source of oxygen (& blender) Auscultate stethoscope Pulse oximeter (if possible) Intubation equipment

Key behavior skills

Know your environment Anticipate & plan Call for help & work as a team The person present must initiate resuscitation Communicate effectively Use all available resources

SUMMARY

Effective Resuscitation

Airway & Breathing

Circulation Drugs

Summary
Everybody who conducts a delivery must be able to resuscitate We should be prepared at all times Lets give our newborn a good start