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Postnatal Assessment
and Resuscitation
Ghazi Alotaibi, PhD, RRT
Lec05-Sep27
Critical Moments in
Everybody’s Life
The first moments of life
are very critical.
From intrauterine life to
extrauterine life
Need to establish new
pattern of circulation.
Need to establish new
system for gas exchange.
Steps for Proper Care
of Newborn
Step 1: Preparation.
Step 2: Stabilization.
Step 3: Assessment.
Step 4: Resuscitation.
Step 1: Preparation
Anticipation of high risk delivery
Maternal history, history of pregnancy, monitoring
during labor and delivery.
Skilled personnel should be available (MD,
RT, RN).
Availability of prearranged plan.
Availability of Equipment
Different sizes (resus. bags, masks).
Check for proper function.
Radiant warmer
Step 2: Stabilization.
A. DRY AND WARM:
Once delivered, newborn is dried and warmed to
prevent heat loss.
Warmed in preheated radiant warmer, or warmed
blankets.
What is the mechanism of heat loss in Neonates?
For babies <1500 g, use polyethylene wrapping to
prevent heat loss but allows radiant heat transfer.
B. MAINTAIN OPEN AIRWAYS:
Neck slightly flexed.
Small roll under the shoulder.
If no respiratory effort, reposition the head.
Suction mouth, then nose using bulb syringe
or suction catheter.
Suction may cause bradycardia WHY??
Suction: depth< 5 cm, for 5 sec, suction
pressure <100 mm Hg.
If meconium is suspected:
Suction moth, pharynx, and nose as the head
is delivered.
No stimulation until the airway is cleared,
Why??
If signs of distress are present with the
present of meconium: Intubate, Suction,
Extubate.
C. Stimulation:
If no strong cry, respi. effort, limb movement:
Stimulate baby.
How?
Flicking the bottom of the feet
Rubbing the back
No shaking, spanking or upside down holding.
If no effective spont. breathing after
stimulation: start resuscitation.
Step 3: Assessment of
Neonate
Assessment should evaluate:
Respiratory effort.
HR
Color
APGAR Score
Visual assessment of external structures.
Respiratory Effort:
Normally: spontaneous crying with adequate
respiratory arte and depth.
Inadequate respiration (absent, shallow,
gasping): PPV with 100% oxygen.
Shallow breathing could be deceiving (does
not guarantee adequate pulse rate). WHY?
Hear Rate:
How to assess HR in Neonates?
a. Grasping the base of the umbilical cord.
b. Stethoscope.
c. Feeling brachial or femoral pulse.
If HR < 100: PPV
If HR < 60 start chest compressions.
Color:
Not sensitive indicators of baby’s condition as
heart rate.
Peripheral cyanosis is common shortly after
birth. Why?
Oxygen may not be necessary.
If central cyanosis is present with adequate
respiration and HR > 100: give oxygen.
APGAR Score
Evaluate 5 factors. (HR, RR, Color, Reflex,
and muscle tone)
Provides a clinical pictures of baby’s
condition after delivery.
APGAR score at 1-min help guide the
appropriate clinical intervention.
Still the best index of postnatal health.
Resuscitation has the priority over assigning
APGAR scoring.
APGAR score is performed at 1- and 5-min.
Why at 5-min??
Interpretation of APGAR Scores:
7-10: Observe
4-6: O2 and stimulation
0-3: Resuscitate.
If < 7, APGAR score should be repeated
every 5 minutes until score > 7.