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  • Subsequent Management: Meconium Aspiration

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    angelras
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    Subsequent management If the response to resuscitation is prompt and the baby is pink, vigorous, and crying, hand to parents. If there are no signs of life after 10 minutes of continuous adequate resuscitation with ventilation, cardiac compressions, drugs, and volume expansion, discontinuation of resuscitation should be discussed with a senior paediatrician. Record Apgar scores (Table 4.2). Risk factors Fetal distress, instrumental delivery, meconium-stained liquor. Maternal opioid administration, general anaesthetic. Multiple births, preterm delivery, shoulder dystocia. Exclusions Hypovolaemia—baby remains very pale despite good ventilation and reasonable heart rate. Give 20 mL/kg O-negative blood via the umbilical vein (0.9% saline if blood not available). May need to be repeated. Diaphragmatic hernia—diffi cult to establish lung infl ation, displaced apex, scaphoid abdomen. Pass wide-bore nasogastric tube and empty the stomach. Intubate to avoid further mask ventilation. Pneumothorax—tension pneumothoraces can develop during resuscitation. Poor air entry on one or both sides. Heart sounds quiet. If condition too critical to await X-ray, needle anterior chest wall, second intercostal space, mid-clavicular line, aspirating air using 20 mL syringe and three-way tap. Hydrops fetalis—many causes of this condition. Infants are born with severe generalized oedema and may have ascites, pleural, or pericardial effusions. Poor response to resuscitation may be improved by draining effusions and ascites with a needle or cannula. Congenital complete heart block. Baby has good colour, tone, and respiration but heart rate remains around 60 bpm. Good pulses. No further resuscitation is needed. Transfer to neonatal unit for further investigation. Macerated stillbirth. No heart beat detectable at any stage after birth. Skin sloughage, abdominal discoloration. Baby has been dead in utero for some time. Further resuscitation is pointless. Special considerations Meconium aspiration Most infants with meconium-stained liquor are in good condition. If baby is vigorous, no further airway management is required. If baby is fl oppy, with absent or poor respiratory effort, visualize the vocal cords with a laryngoscope and suction trachea below cords under direct vision using a wide-bore catheter (see Table 4.3). Repeat suction until airway is clear before applying positive pressure ventilation as required. • • • • • • • • • • • • • • • NEONATAL RESUSCITATIONSubsequent management If the response to resuscitation is prompt and the baby is pink, vigorous, and crying, hand to parents. If there are no signs of life after 10 minutes of continuous adequate resuscitation with ventilation, cardiac compressions, drugs, and volume expansion, discontinuation of resuscitation should be discussed with a senior paediatrician. Record Apgar scores (Table 4.2). Risk factors Fetal distress, instrumental delivery, meconium-stained liquor. Maternal opioid administration, general anaesthetic. Multiple births, preterm delivery, shoulder dystocia. Exclusions Hypovolaemia—baby remains very pale despite good ventilation and reasonable heart rate. Give 20 mL/kg O-negative blood via the umbilical vein (0.9% saline if blood not available). May need to be repeated. Diaphragmatic hernia—diffi cult to establish lung infl ation, displaced apex, scaphoid abdomen. Pass wide-bore nasogastric tube and empty the stomach. Intubate to avoid further mask ventilation. Pneumothorax—tension pneumothoraces can develop during resuscitation. Poor air entry on one or both sides. Heart sounds quiet. If condition too critical to await X-ray, needle anterior chest wall, second intercostal space, mid-clavicular line, aspirating air using 20 mL syringe and three-way tap. Hydrops fetalis—many causes of this condition. Infants are born with severe generalized oedema and may have ascites, pleural, or pericardial effusions.

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    Subsequent management If the response to resuscitation is prompt and the baby is pink, vigorous, and crying, hand to parents. If there are no signs of life after 10 minutes of continuous adequate resuscitation with ventilation, cardiac compressions, drugs, and volume expansion, discontinuation of resuscitation should be discussed with a senior paediatrician. Record Apgar scores (Table 4.2). Risk factors Fetal distress, instrumental delivery, meconium-stained liquor. Maternal opioid administration, general anaesthetic. Multiple births, preterm delivery, shoulder dystocia. Exclusions Hypovolaemia—baby remains very pale despite good ventilation and reasonable heart rate. Give 20 mL/kg O-negative blood via the umbilical vein (0.9% saline if blood not available). May need to be repeated. Diaphragmatic hernia—diffi cult to establish lung infl ation, displaced apex, scaphoid abdomen. Pass wide-bore nasogastric tube and empty the stomach. Intubate to avoid further mask ventilation. Pneumothorax—tension pneumothoraces can develop during resuscitation. Poor air entry on one or both sides. Heart sounds quiet. If condition too critical to await X-ray, needle anterior chest wall, second intercostal space, mid-clavicular line, aspirating air using 20 mL syringe and three-way tap. Hydrops fetalis—many causes of this condition. Infants are born with severe generalized oedema and may have ascites, pleural, or pericardial effusions. Poor response to resuscitation may be improved by draining effusions and ascites with a needle or cannula. Congenital complete heart block. Baby has good colour, tone, and respiration but heart rate remains around 60 bpm. Good pulses. No further resuscitation is needed. Transfer to neonatal unit for further investigation. Macerated stillbirth. No heart beat detectable at any stage after birth. Skin sloughage, abdominal discoloration. Baby has been dead in utero for some time. Further resuscitation is pointless. Special considerations Meconium aspiration Most infants with meconium-stained liquor are in good condition. If baby is vigorous, no further airway management is required. If baby is fl oppy, with absent or poor respiratory effort, visualize the vocal cords with a laryngoscope and suction trachea below cords under direct vision using a wide-bore catheter (see Table 4.3). Repeat suction until airway is clear before applying positive pressure ventilation as required. • • • • • • • • • • • • • • • NEONATAL RESUSCITATIONSubsequent management If the response to resuscitation is prompt and the baby is pink, vigorous, and crying, hand to parents. If there are no signs of life after 10 minutes of continuous adequate resuscitation with ventilation, cardiac compressions, drugs, and volume expansion, discontinuation of resuscitation should be discussed with a senior paediatrician. Record Apgar scores (Table 4.2). Risk factors Fetal distress, instrumental delivery, meconium-stained liquor. Maternal opioid administration, general anaesthetic. Multiple births, preterm delivery, shoulder dystocia. Exclusions Hypovolaemia—baby remains very pale despite good ventilation and reasonable heart rate. Give 20 mL/kg O-negative blood via the umbilical vein (0.9% saline if blood not available). May need to be repeated. Diaphragmatic hernia—diffi cult to establish lung infl ation, displaced apex, scaphoid abdomen. Pass wide-bore nasogastric tube and empty the stomach. Intubate to avoid further mask ventilation. Pneumothorax—tension pneumothoraces can develop during resuscitation. Poor air entry on one or both sides. Heart sounds quiet. If condition too critical to await X-ray, needle anterior chest wall, second intercostal space, mid-clavicular line, aspirating air using 20 mL syringe and three-way tap. Hydrops fetalis—many causes of this condition. Infants are born with severe generalized oedema and may have ascites, pleural, or pericardial effusions.

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    Subsequent Management: Meconium Aspiration

    Uploaded by

    angelras
    Subsequent management If the response to resuscitation is prompt and the baby is pink, vigorous, and crying, hand to parents. If there are no signs of life after 10 minutes of continuous adequate resuscitation with ventilation, cardiac compressions, drugs, and volume expansion, discontinuation of resuscitation should be discussed with a senior paediatrician. Record Apgar scores (Table 4.2). Risk factors Fetal distress, instrumental delivery, meconium-stained liquor. Maternal opioid administration, general anaesthetic. Multiple births, preterm delivery, shoulder dystocia. Exclusions Hypovolaemia—baby remains very pale despite good ventilation and reasonable heart rate. Give 20 mL/kg O-negative blood via the umbilical vein (0.9% saline if blood not available). May need to be repeated. Diaphragmatic hernia—diffi cult to establish lung infl ation, displaced apex, scaphoid abdomen. Pass wide-bore nasogastric tube and empty the stomach. Intubate to avoid further mask ventilation. Pneumothorax—tension pneumothoraces can develop during resuscitation. Poor air entry on one or both sides. Heart sounds quiet. If condition too critical to await X-ray, needle anterior chest wall, second intercostal space, mid-clavicular line, aspirating air using 20 mL syringe and three-way tap. Hydrops fetalis—many causes of this condition. Infants are born with severe generalized oedema and may have ascites, pleural, or pericardial effusions. Poor response to resuscitation may be improved by draining effusions and ascites with a needle or cannula. Congenital complete heart block. Baby has good colour, tone, and respiration but heart rate remains around 60 bpm. Good pulses. No further resuscitation is needed. Transfer to neonatal unit for further investigation. Macerated stillbirth. No heart beat detectable at any stage after birth. Skin sloughage, abdominal discoloration. Baby has been dead in utero for some time. Further resuscitation is pointless. Special considerations Meconium aspiration Most infants with meconium-stained liquor are in good condition. If baby is vigorous, no further airway management is required. If baby is fl oppy, with absent or poor respiratory effort, visualize the vocal cords with a laryngoscope and suction trachea below cords under direct vision using a wide-bore catheter (see Table 4.3). Repeat suction until airway is clear before applying positive pressure ventilation as required. • • • • • • • • • • • • • • • NEONATAL RESUSCITATIONSubsequent management If the response to resuscitation is prompt and the baby is pink, vigorous, and crying, hand to parents. If there are no signs of life after 10 minutes of continuous adequate resuscitation with ventilation, cardiac compressions, drugs, and volume expansion, discontinuation of resuscitation should be discussed with a senior paediatrician. Record Apgar scores (Table 4.2). Risk factors Fetal distress, instrumental delivery, meconium-stained liquor. Maternal opioid administration, general anaesthetic. Multiple births, preterm delivery, shoulder dystocia. Exclusions Hypovolaemia—baby remains very pale despite good ventilation and reasonable heart rate. Give 20 mL/kg O-negative blood via the umbilical vein (0.9% saline if blood not available). May need to be repeated. Diaphragmatic hernia—diffi cult to establish lung infl ation, displaced apex, scaphoid abdomen. Pass wide-bore nasogastric tube and empty the stomach. Intubate to avoid further mask ventilation. Pneumothorax—tension pneumothoraces can develop during resuscitation. Poor air entry on one or both sides. Heart sounds quiet. If condition too critical to await X-ray, needle anterior chest wall, second intercostal space, mid-clavicular line, aspirating air using 20 mL syringe and three-way tap. Hydrops fetalis—many causes of this condition. Infants are born with severe generalized oedema and may have ascites, pleural, or pericardial effusions.

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    Subsequent management

    If the response to resuscitation is prompt and the baby is pink, vigorous,


    and crying, hand to parents.
    If there are no signs of life after 10 minutes of continuous adequate
    resuscitation with ventilation, cardiac compressions, drugs, and volume
    expansion, discontinuation of resuscitation should be discussed with a
    senior paediatrician.
    Record Apgar scores (Table 4.2).
    Risk factors
    Fetal distress, instrumental delivery, meconium-stained liquor.
    Maternal opioid administration, general anaesthetic.
    Multiple births, preterm delivery, shoulder dystocia.
    Exclusions
    Hypovolaemiababy remains very pale despite good ventilation and
    reasonable heart rate. Give 20 mL/kg O-negative blood via the umbilical
    vein (0.9% saline if blood not available). May need to be repeated.
    Diaphragmatic herniadiffi cult to establish lung infl ation, displaced
    apex, scaphoid abdomen. Pass wide-bore nasogastric tube and empty
    the stomach. Intubate to avoid further mask ventilation.
    Pneumothoraxtension pneumothoraces can develop during
    resuscitation. Poor air entry on one or both sides. Heart sounds quiet.
    If condition too critical to await X-ray, needle anterior chest wall,
    second intercostal space, mid-clavicular line, aspirating air using 20 mL
    syringe and three-way tap.
    Hydrops fetalismany causes of this condition. Infants are born with
    severe generalized oedema and may have ascites, pleural, or pericardial
    effusions. Poor response to resuscitation may be improved by draining
    effusions and ascites with a needle or cannula.
    Congenital complete heart block. Baby has good colour, tone, and
    respiration but heart rate remains around 60 bpm. Good pulses. No
    further resuscitation is needed. Transfer to neonatal unit for further
    investigation.
    Macerated stillbirth. No heart beat detectable at any stage after birth.
    Skin sloughage, abdominal discoloration. Baby has been dead in utero
    for some time. Further resuscitation is pointless.
    Special considerations
    Meconium aspiration
    Most infants with meconium-stained liquor are in good condition. If
    baby is vigorous, no further airway management is required.
    If baby is fl oppy, with absent or poor respiratory effort, visualize the
    vocal cords with a laryngoscope and suction trachea below cords
    under direct vision using a wide-bore catheter (see Table 4.3).
    Repeat suction until airway is clear before applying positive pressure
    ventilation as required.

    NEONATAL RESUSCITATION

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