Neonatal Resuscitation Programme/ NRP /Basic Resuscitation of the Newborn baby/ Neonatal Resuscitation/ Newborn Resuscitation
After birth, umbilical cord is clamped and cut, stop delivery of oxygen from placenta.
If baby doesn't start breathing immediately after birth
Cause asphyxia
Basic Resuscitation helps to baby attain normal breathing.
Increase risk of breathing problems occurs in babies who are-
1. Preterm
2. Born after long traumatic labor
3. Born to mother's who received sedation
4. During late stages of labor
Any baby can have breathing difficult at birth.
Important to anticipate and prepare for resuscitation in all delivery supply.
Keys to successful resuscitation
Skill at resuscitation and know how to recognize babies at risk.
1. Anticipate
2. Be prepared
3. Know what to do (be gentle and fast)
4. In what order
5. To able to work quickly in coordination
6. Document/ record
7. Maintain hygiene
8. Focus on mother needs
Preparing delivery room
Preparation before resuscitation;
Structured check of equipment and supplies.
Identify roles
Accurate documentation
Steps of Neonatal Resuscitation
TABC for Resuscitation
1. T; maintenance of Temperature
2. A; Establish an open Airway
3. B; Initiate Breathing
4. C; Circulation (chest compressions)
1. Position
Sniffing position, use shoulder role.
2. Clear airway
Suction, mouth first then nose.
3. Dry
Dry thoroughly
4. Stimulate
Foot flicks
5. Reassess or reposition
Reassess breathing or reposition if stll no proper breathing.
Airway Management
Relieved by;
1. Head tilt, chin lift, or
2. Jaw thrust
Chest compression technique
1. Two thumb technique
2. Two finger technique
1. Two thumb technique
Encircling throax with both band, using two thumb directed at 90 degree to chest.
Place both hands under infants chest, both thumb are now placed on lower half of infant sternum.
Steps;
Pressing sternum compress heart between sternum and blood squeeze out of heart and into the circulation.
Performed with two thumb with the other finger encircling the chest.
2. Two finger technique
Place two finger in center of chest, compress the sternum with tips of two finger.
Compress at least 1 and half inches (4cm) depth of chest.
Compression is performed with index and middle fingers, placed on the sternum just below nipples.
Assessing need of Resuscitation at Birth
1. Note the 5ume of birth.
2. Receive baby in dry warm linen
3. Is baby breathing (chest move equally both sides with no difficulty between 40 to 60 minutes breathe per minute) or crying?
4. If yes, provide routine Care
5. If no baby require resuscitation starting with initial steps.
If baby is not Breathing/Crying
Provide initial steps;
1. Cut cord immediately and place baby under radiant warmer.
2. Provide initial steps;
a. Dry
Dry baby thoroughly under radiant warmer and remove wet linen.
b. Position
Place folded piece of cloth under baby shoulder to help maintain position.
c. Clear airway
Suction mouth first then nose.
May require suctioning the trachea to remove meconium.
d. Tactile stimulus to stimulate baby to breathe
e. Reposition the head to maintain an open Airway.
f. Evaluate respiration and heart rate of baby after 30 second of initial steps.
What to do if heart rate or respiration is abnormal?
On evaluation of breathing and heart rate after initial steps.
If apneic or gapsing respiration or heart rate <100 b/m.
Provide positive pressure ventilation (PPV)
If baby chest rising; PPV adequate
Ventilate at rate 40 breaths/minutes
Squeez bag (ventilate) at 40 times a minutes untill baby start crying or breathing.
Assess for spontaneous breathing and heart rate .
If spontaneous breathing present and hear rate 100 or more; gradually discontinue PPV.
When to stop ventilation
After 30 second of bag and mask ventilation.
Reassess respiratory effort, heart rate, oxygen saturation
Is baby crying? Yes- stop ventilation
Is baby breathing regularly at >30 b/m, if yes - stop ventilation
Does baby have in-drewing of chest wall? if no - then stop ventilation
If still chest in-drewing, indicate difficulty in Breathing, need support for breathing, can continue with CPAP or free flow of ventilation.
If no improvement after 30 seconds, what is to be done.
Continue to do bag and mask ventilation and assess need for chest compression.
Problem
Heart rate above 100 beats/minutes.
Remedial steps;
Stop ventilation, if spontaneous respiration.
If gasping or not breathing, continue ventilation.
Problem
60 to 100 beats/minutes
Remedial steps;
Continue bag and mask ventilation
Problem
Below 60 beats/minutes
Remedial steps;
Begin chest compression, continue to ventilation.
Note- Ventilation is more important during resuscitation, should be continued even while administering chest compression.
Chest Compression and Ventilation
Heart circulates blood throughout body delivering oxygen to vital organs.
When infant becomes hypoxic, heart rate slows and myocardial contractility decreases.
Result diminished flow of blood and oxygen to vital organs.
Decreased supply of oxygen lead to irreversible damage to brain, heart, kidney and bowel.
Chest compression;
Used to temporarily increase circulation and oxygen delivery.
Ventilation
Given oxygen, blood circulated during chest compression gets oxygenated.
After 30-45 second of chest compression, heart rate of baby re-assessed.
If heart rate still less than 60 per minute, chest compression should be continue with PPV after administering injection Adrenaline.
Coordinating Ventilation and Chest Compression
For every 3 compression 1 breathe is delivered.
(In a minute 90 compression and 30 breaths given; total 120 events)
Medication
Adrenaline and volume expanders (saline, ringer lactate); administerd during resuscitation.
When adequate PPV ventilation and chest compression, together for more than 45 sec to 1 minute, heart rate remains or <60 beats/minutes.
What to do in case no improvement
Babies requiring chest compressions, intubation and medication.
Follow on care after Successful Resuscitation
1. Observation care at mother's bed side.
2. Newborn have required PPV for less than one minute, provided observation care.
3. Provide warmth
4. Initia breastfeeding
5. Monitor new born (temperature, heart rate, breathing, color every 30 minutes for 2 hours.
6. Post resuscitation care;
Babies who received PPV for more than a 1 minute or more extensive resuscitation like intubation, chest compression.
Managed in special care newborn unit.
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