Newborn resuscitation

Background

NEWBORN VITAL SIGNS

HR RR SBP*

>100 40-80 60-70

• <3kg (premature) SBP = 40-60

DDx

COMMON NEWBORN PROBLEMS

1) Hypoxia

    a) Primary apnea

    b) Secondary apnea

2) Hypothermia

3) Hypoglycemia

4) Meconium asp

Consider DDx (esp if older neonate)

1) Sepsis

2) Congenital Heart Dz (PGE)

3) Inborn Error of Metabolism (lactate)

Diagnosis

ASSESSMENT TRIAD

1) Respiration- adequacy, difficulty

2) HR >100, umbilical

3) Color

Treatment

RESUSCITATION INVERSE PYRAMID

1) Dry, warm, position, suction, stimulate

    a) position: neutral

    (towel --> thorax)

    b) suction: oral then nasal

    c) stim: along spine or feet

    d) check glucose*

2) Oxygen (use liberally)

3) Ventilate (40-60 breaths/min @ 20-25 cmH20)

    a) BVM (indications)

         i) Apnea/gasping

         ii) HR <100/min

         iii) Persistent cyanosis

    b) ET** (indications)

    ETT size = Gest age (wks) / 10

         i) BVM ineffect after 30s

         ii) Suction meconium**

4) Chest compressions (indications)

    a) HR <60 after above x 30 sec

         i) 120/min (resp 3:1)

         ii) Stop when HR > 60

5) Medications****

(if HR <60 despite above)

    a) Epi (0.01-0.03 mg/kg)

    b) D10W (4 mL/kg = 0.2gm/kg)

    c) Nalaxone (0.4 mg/kg)

         i) For opiod use <4hrs

    d) NS (10 mL/kg boluses)

    e) Dopamine gtt

    (5-20 mcg/kg/min)

    f) NaHCO3 - prolonged resus

    (1-2 meQ/kg)

• HYPOGLYCEMIA (give D10W)

>2.5 kg = <40 mg/dL

<2.5 kg = <30 mg/dL

• • MECONIUM SUCTIONING INDICATIONS

Meconium + -->

1) absent/depressed resp

2) poor muscle tone

3) HR <100

(2 passes w/ ET + suction)

• • • NEWBORN VENT SETTINGS

Pressure Cycled: RR 30+, PIP 20/2 (Preemie 15/2)

• • • • UMBILICAL VEIN ACCESS

1) Cut cord 1 & 1/2 inch

2) 5F cath, 3-way stopcock

3) Feed the 'mouth'

3) Place until get blood flow (-4 cm)

DETERIORATION AFTER INTUBATION

D - Displacement (flexion pushes in, exten pulls it out)

O - Obstruction of tube

P - PTX

E - Equipment failure

PREEMIE (<23-24 wks or 500 gms)

1) rapid volume may inc risk of IVH

2) usually ETT immed

GROUP B SEPSIS

1) Early (1dy-1wk)

    a) p/w PNA, meningitis, sepsis

    b) risk factors

         i) premature

         ii) maternal fever

         iii) PROM> 18 hrs

         iv) low wt.

2) Late (2-4 wks)

    a) p/w meningitis

APGAR: 0 1 2

HR absent <100 >100

Resp absent slow,irr good

Tone limp some flex active

Color blue,pale blue ext pink

Reflex no resp grimace cough

Equipment

- blankets, warmer, umbilical clamps

- Bulb suction or wall suction

- Catheters (5F,8F,10F)

- Meconium aspirators

- BVM

- ETT 2.5-4.0 w/ stylets

- Blades 0 & 1

- IV catheters (22 & 24 g)

- Umbilical caths (3.5 F & 5F)

- syringes, 3 way stop cocks

- Epi 1:10,000

- Naloxone 0.4 mg/ml or 1 mg/ml

- NaHCO3 4.2% or 8.4%

- NS & D10W

Source

2/26/05 DONALDSON (adapted from Rosen, Lampe, Young)