Lec05 Neonatal Assess Resuscitation

King Faisal University College of Applied Medical Sciences Respiratory Care Department MSRT411: Perinatal and Pediatric Respiratory Care

Postnatal Assessment and Resuscitation Ghazi Alotaibi, PhD, RRT Lec05-Sep27

Critical Moments in Everybody’s Life 

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The first moments of life are very critical. From intrauterine life to extrauterine life 

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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 

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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:

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Once delivered, newborn is dried and warmed to prevent heat loss. Warmed in preheated radiant warmer, or warmed blankets.

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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.

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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.

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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.

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C. Stimulation: If no strong cry, respi. effort, limb movement: Stimulate baby. How?   

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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.

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Respiratory Effort:

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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?

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Hear Rate:

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How to assess HR in Neonates? a. b. c.

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Grasping the base of the umbilical cord. Stethoscope. Feeling brachial or femoral pulse.

If HR < 100: PPV If HR < 60 start chest compressions.

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Color:

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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.

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APGAR Score 

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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.

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APGAR score is performed at 1- and 5-min. Why at 5-min?? Interpretation of APGAR Scores:   

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7-10: Observe 4-6: O2 and stimulation 0-3: Resuscitate.

If < 7, APGAR score should be repeated every 5 minutes until score > 7.