Approximately one million babies die per year in world wide, due to not ventilated / resuscitate properly or no skilled birth attendant. 1/3rd, approximately 3 lac babies died in India.
The ventilation need always be anticipated. At the time of child birth adequate ventilation is more important than the additional oxygen. Quick action with bag and mask is more important than the intubation. Advance procedures are needed only for small proportion of cases (chest compression, intubation, use of drugs).
Neonatal resuscitation means to revive or restore life to a baby from the state of asphyxia.
- Assess a newborn baby at birth
- Perform resuscitation of a newborn baby using standard equipment
- Provide aftercare if a baby requires help with its breathing at the time of birth
Key to Successful Resuscitation
- Call for help
- Be gentle
- Provide warmth
- Maintain hygiene
Preparation for Birth
- A draft free, warm room with temperature ≥ 25o
- A clean, dry and warm delivery surface.
- A radiant warmer/ overhead lamp with 200 watt bulb if available
- Two clean, warm towels/clothes
- A folded piece of cloth ( ½ to 1 inch thick) (Shoulder roll)
- A new born size self-inflating bag (250 / 500 ML)
- Infant masks in two sizes: size ‘1’ for normal weight baby and ‘0’ for small baby
- A suction device
- Oxygen ( if available)
- A clock with second hand
|Provide Warmth||Provide Warmth||Provide Warmth|
|Suction Mouth And Nose( If Necessary)||Observe Breathing And Temperature||Observe Breathing, Temperature, Color, CFT.|
|Cut Cord In 1-3 Minutes||Watch For Complications||Monitor Blood Sugar|
|Keep Baby With Mother||Initiate Breast Feeding , If Well||Watch For Complications|
|Initiate Breast Feeding||Initiate Breast Feeding, If Well|
|Complications Like: – Convulsion, Coma, Poor Feeding, Lethargy, Respiratory Distress Etc.|
Neonatal Resuscitation Program
- Preparation of birth
- Routine care
- Initial steps
- Brief ventilation
- Prolonged ventilation with normal heart rate
- Prolonged ventilation with slow heart rate
Preparation of Birth
- Preparing a helper, who is going to help us throughout the delivery of the mother.
- Preparing the environment (warm & prevent drafts of air )
- Preparing yourself – hand washing
- Preparing the equipment : – checking the functions of ambu bag and mask
- Provide warmth
- Suction mouth and nose (if meconium present) placing the tube not more than 5cm in mouth & not more than 2cm in nose inside.
- Dry the baby and observe for crying or breathing whilst drying
- Assess the baby’s breathing- ( chest rising symmetrically with frequency 30-60/minute, chest in drawing, and grunting ) if normal
- Tie and cut the cord
- Keep baby with mother
- Initiate breast feeding
Assess the breathing – If Not Normal
Use 3 ‘T’
- Tell the mother
- Tie & cut the cord
- Transfer the baby
- Position the head- (sniffing position) with head and neck extended by using shoulder roll
- Suction the mouth & the nose
- Stimulate to breath by slapping or flicking the soles of the feet, Gently rubbing the newborns back or extremities (any one method)
- Reposition the Baby
Characteristics of Breathing
See whether baby is breathing or not, if baby breathing then, observe following things….
- Rate of Breathing
- Symmetrically rising of chest
- In drawing of chest
After PSSR – No Response
- Select appropriate sized bag & mask & start to ventilate the newborn at the rate of 40-60 breaths /minute
- By saying breath two three, breath two three (squeeze the bag on breath and release while you say two three.) Position ‘E’ and ‘C’ shape of letter
Again assess breathing – No Proper Response
Use MR. SOPA
- Mask and head Reposition
- Suction the mouth and nose
- Open mouth slightly
- Pressure to be increased
- Alternative Airways (Oxygen)
Prolonged Ventilation With Normal Heart Rate
After MR. SOPA – No Response
- Call for help ,
- Oxygen to be provided through bag and mask
Assess the Heart Rate – if >100/bpm
- Continue ventilation & re-assess after every 30 seconds – if spontaneous breathing started
- Re-assess the new born’s breathing
- Gradually discontinue positive pressure ventilation
- Observational care
Prolonged Ventilation with Slow Heart Rate
- After ‘MR. SOPA’ and ‘HO’
- Still the heart rate is slow
- Continue to do bag and mask ventilation and re assess heart rate approximately after every 30 seconds, in the meantime call the doctor for advanced care.
- Arrange for referral.
- Ventilation should continue uninterrupted during the transport process.
- If there are no signs of life ( breathing/heart rate) even after 20 minutes of birth, ventilation may be stopped.