NEONATAL CARE AND

RESUSCITATION

Rahul H Gujarathi
Basic principles of neonatal care

 Ensure adequate oxygenation through clear

airway
 Prevent hypothermia
 Assessment of need for resuscitation
 Early initiation of enteral feeds to normal
infants
 Prevention of infections
Need of neonatal care and
resuscitation

The process of birth is transition from the

fluid surrounded intra-uterine life to the air
surrounded extra-uterine life. Oxygen in the
IUL is provided by the mother where as in the
EUL, it is the baby who has to inhale it to
maintain the homeostasis.
Components of neonatal care

 Detail obstetric history

 Identification of risk factors
 Well illuminated and ventilated labour room
 Supportive instruments and drugs for revival,
if required
 Wall clock in working condition with second’s
hand
 A team of two for resuscitation if necessary
Basic requirements of neonatal care

 Warm and clean environment

 Sterile tray to receive the baby
 Pre-warmed sterile towels
 Suction machine and suction catheters of
different sizes or mucus suckers
 Cord clamp
 Weighing scale
Normal neonatal care

 Follow all the procedures in an warm

environment
 Clear the oro-pharynx and the naso-pharynx of
the secretions
 Dry the newborn
 Asses the haemo-dynamic status
 Check for life threatening anomalies
 Cord care
 Ophthalmic care
Normal neonatal care

 Gastric lavage, if necessary

 Identity tag
 Vitamin K injection
 Detailed examination and assessment of the
baby
 Transfer to mother, start and monitor breast
feeding
Immediate monitoring

 Monitor feeding and hydration of the baby

followed by proper burping
 Monitor temperature and other vitals
 Monitor the activity of the baby
 Passage of meconeum and urine
 Observe for abnormal signs like apnea,
convulsions, haematomas, etc. in case of
preterm neonates or those delivered of
difficult or prolonged labour
Neonates at risk

 Preterm neonates
 Post term neonates
 MSAF
 Ante natal detection of congenital anomaly
 SFD neonates
 Peri-natal hypoxia
 Diabetic mother
 Rh iso-immunization
Equipments of resuscitation

 All equipments required in normal neonatal care

 Suction machine and large bore suction
catheters
 Free flow of oxygen
 Resuscitation bag with varying size face masks
 Laryngoscope with suitable blades and endo-
tracheal tubes of varying size
 Medicines like epinephrine, naloxone, saline
infusion, sodium bicarbonate
Checking the equipments

 Check for the content of oxygen cylinder

 Check the safety valve or resuscitation bag
 Assess the cleanliness of face mask and
sterility of catheters and endo-tracheal tubes
 Illumination source of laryngoscope
 Expiry date of the medications
Components of resuscitation

 T  Temperature
 A  Airway
 B  Breathing
 C  Circulation
Steps of resuscitation
Birth / Delivery

Was the liquor clear of meconeum?

Did the baby cry? Clear Airways
Is the activity of the child adequate? Yes Dry the baby
Is the baby Pink? Provide warmth
Is the baby full term or near full term?

NO Improved

30 seconds
Heart rate > 100 per minute Reposition the baby
Respiratory effort seen Yes Clear airway and stimulate
Only peripheral cyanosis Give oxygen as necessary

NO

Heart rate < 100 but > 60 per minute

Minimal respiratory effort / Gasp Yes Provide positive pressure ventilation 30 seconds
Cyanosis HR > 100, respiratory efforts seen, pink
Limp / Minimal activity Continue ongoing care

NO

Heart rate < 60 per minute

Apnea / Gasps Yes Provide positive pressure ventilation
Limp Apply Chest Compressions 30 seconds
Centrally cyanosed HR > 60, respiratory efforts seen
Continue ongoing care
HR < 60 HR > 60

Administer epinephrine
Continue positive pressure ventilation
Continue chest compressions
Process of resuscitation

 Stabilization: Provide warmth, positioning,

clear airway, stimulation, oxygenation
 Ventilation: Bag and mask or bag and tube
 Chest or cardiac compressions
 Administration of drugs
Stabilization* * 30 seconds

 Prevent loss of heat through convection

 Place the baby under warmer and dry it,
remove wet linen
 Position the baby to semi extend the neck
and clear airway
 Gentle tactile stimulation by flicking or
rubbing
 Free flow of oxygen or through the face mask
@ 5 liters per minute
Ventilation* * 30 seconds

Indications of IPPV:
 Indications of bag and mask ventilation:
Apnea / gasps
HR < 100 but > 80
Central cyanosis despite free supply of oxygen
 Indications of endo-tracheal intubation:
Severe pre-maturity
No response to bag-mask ventilation
HR < 80
Administration of drugs
Meconeum aspiration
Ante-natal diagnosis of diaphragmatic hernia
IPPV

 Neck should be in a semi extended position

 Give positive breaths @ 40 per minute, initial
10-20 with a pressure @ 30-40 cm of water
followed by the rest @ 15-20 cm of water
 Bag ventilation provides oxygen of about 90-
100% concentration if attached to a reservoir
Compressions* * 30 seconds

Indication for chest compression:

Not responding to IPPV and detoriation of condition
HR < 60 per minute
Process of compressions:
Apply compressions just above the xiphisternum
Apply it rhythmically
Maintain rate as 3 compressions : 1 ventilation
Use two finger or the thumb method
Co-ordinate ventilation
Medications

 Epinephrine 1:10000 dilution @ 0.1ml/kg/dose IV /

SC / ET. Can repeat the dose – max thrice
 Naloxone 0.1mg/kg IV / SC / ET if narcotics are
used, to be given after establishing ventilation
 Sodium bicarbonate 7.5% 2ml+2ml D.W./kg slow IV
if suspicion of metabolic acidosis, or apnea / gasps
after 5 minutes of ventilation. Preferably given after
establishing ventilation
 0.9% normal saline 10ml/kg IV in shock
Gastric lavage

 Babies born by cesarean section

 Severe asphyxia
 MSAF
 Poly-hydramnios
 Single umbilical artery
 SFD / IUGR
 Neonates of diabetic mother
 H/O infection, suspicion of pneumonia, sepsis
Special condition - MSAF

Do’s
 Suction the pharynx before delivery of shoulders
 Suction trachea
 Asses activity
 Give gastric lavage
 Monitor respiration
Don'ts
 Bag and mask ventilation
 Stimulate vigorously
Monitor throughout

 Colour of baby
 Respiratory efforts, rate
 Heart rate
 Temperature
 Airway patency
 Air entry in the lungs
Stop CPR

ETHICAL OR UNETHICAL, THE DEBATE WILL

CONTINUE. Stop if
 Prolonged and intractable asphyxia
 No signs of life after 10 minutes of resuscitation
 No spontaneous breathing effort at 30 min of
resuscitation
 Gross neuro-motor disability or poor quality of life
even after complete revival
 Gross and non correctable congenital anomalies
 Extreme pre-mature and micropremies
Investigate

 Cord blood pH in every asphyxiated baby

 CXR for every intubated baby or for every baby
delivered of MSAF
 Sepsis screening, ABO Rh grouping
 RFT, LFT, coagulation profile in case of prolonged
asphyxia
 Neuro-scanning – USG brain
 Auditory tests
 Cardiac screening in case of 2 vessel cord