PHYSIOLOGICAL BASIS OF

RESUSCITATION AT BIRTH

Presenter:Dr Kaiser Fitzwanga

Moderator:Prof. Wasunna
 Introduction
 Physiology of the first breath in newborns
 Why resuscitate at birth
 Apnoea
Introduction
 Successful establishment of adequate lung
function at birth is dependent on:
 Airway patency
 Functional lung development
 Maturity of respiratory control
 Foetal lung fluid must be removed and
replaced with gas.
 Process begins before birth as active
sodium transport across the pulmonary
epithelium drives liquid from the lung
lumen into the interstitium with subsequent
absorption into the vasculature.
 Enhanced by increased circulating levels of
catecholamines,vasopressin,prolactin and
glucocorticoids.
 Functional residual capacity must be
established and maintained to develop a
ventilation-perfusion relationship.
Physiology of the first breath
 Initiation of the first breath is due to a decline in
PaO2 and PH,rise in PaCO2 due to interruption
of the placental circulation,redistribution of
cardiac output and decrease in body temperature
and tactile/sensory input.
 Intermittent compression of the thorax facilitates
removal of lung fluid during vaginal delivery.
 Surfactant lining the alveoli enhances the
aeration of the gas-free lungs by lowering
surface tension thus lowering the pressure
required to open the alveoli.
 Expiratory oesophageal pressures
associated with the first few spontaneous
breaths in newborns range from 45-
90cmH2O aiding in establishment of FRC.
 Air entry into the lungs displaces the
fluid,decreases the hydrostatic pressure in
the pulmonary vasculature and increases
pulmonary blood flow.
 The remaining fluid is removed via the
pulmonary lymphatics,upper
airway,mediastinum and the pleural space.
 Fluid removal may be impaired by:
 Post caesarian section
 Surfactant deficiency
 Endothelial damage
 Hypoalbuminaemia
 Neonatal sedation
 Lowbirth weight infants have very compliant
chest wall and may be at a disadvantage in
drawing the first breath compared with term
infants.
 FRC is lowest in the most immature infants
because of decrease in alveolar number.
Why resuscitate at birth?
 The most common delivery room emergency for
neonates is secondary to failure to initiate and
maintain effective respirations.
 Majority of babies undergo a smooth physiologic
transition and breathe effectively after delivery.
 5-10% babies will require active intervention to
establish normal cardiorespiratory function.
 Goals of neonatal resuscitation:
 Prevent the morbity and mortality
associated with hypoxic-ishaemic tissue
injury(brain,heart,kidney)
 Re-establish adequate spontaneous
respiration and cardiac output
Apnoea
 Is a common problem in preterm infants that may
be due to prematurity or an associated illness.
 Periodic breathing-regular sequence of
respiratory pauses of 5-10 sec interspersed with
periods of hyperventilation of 10-15 sec not
associated with cyanosis or bradycardia.Is more
common in premature infants.
 Periodic breathing must be distinguished from
prolonged apnoeic pauses because the latter may
be associated with serious illness.
 Types of apnoea:
 Central-absence of respiratory effort with no gas
flow
 Obstructive-continued ineffective respiratory
effort with no gas flow
 Hypoxia,which can occur in-utero,intranatal or
post natal,if not intervened and corrected
promptly,can lead to delay in the recovery of the
newborn and permanent brain damage.
 When there is hypoxia,the newborn first responds
by rapid respirations followed by apnoea(primary
apnoea).
 The heart rate starts falling with primary apnoea
and continues to fall further if hypoxia is
continued.
 Following primary apnoea gasping respiration
occurs leading to secondary apnoea.
 THANK YOU