NEONATAL RESUSCITATION

Lesson 1: Foundations of Neonatal

Resuscitation

AMERICAN HEART ASSOCIATION

AMERICAN ACADEMY OF PEDIATRICS
PHILIPPINE SOCIETY OF NEWBORN MEDICINE
FOUNDATIONS OF NEONATAL
RESUSCITATION

• Importance of resuscitation skills

• Physiologic changes during and after birth
• Neonatal Resuscitation Flow diagram format
• Communication and teamwork skills used by effective resuscitation teams
WHY DO NEWBORNS REQUIRE
DIFFERENT APPROACH TO
RESUSCITATION?
ADULT CARDIAC ARREST:
• most often a complication of trauma or existing heart disease
• sudden arrhythmia  ineffective heart contraction  decreased brain circulation  loss of
consciousness  stops breathing
• during the arrest, O2 and CO2 in the blood usually normal
• chest compressions to maintain circulation until electrical defibrillations or medications restore
cardiac functions
WHY DO NEWBORNS REQUIRE
DIFFERENT APPROACH TO
RESUSCITATION?
NEWBORNS NEEDING RESUSCITATION:
• most newborns requiring resuscitation have a health heart
• newborns requiring resuscitation have a problem in respiration  inadequate gas
exchange
• respiratory failure may occur before or during birth
• placenta responsible for in utero respiration
FETAL PHYSIOLOGY

In the fetus:
• alveoli is filled with lung fluid
• in utero, fetus dependent on placenta for gas exchange
FETAL PHYSIOLOGY

In the fetus:
• pulmonary arterioles are constricted
• pulmonary blood flow is diminished
• blood flow is diverted across the patent ductus
arteriosus
AFTER BABY’S BIRTH

Lungs and Circulation After Delivery:

• fetal lung fluid leaves alveoli
• lung expands with air
AFTER BABY’S
BIRTH
• Lungs and Circulation After
Delivery:
• blood oxygen levels rise
• ductus arteriosus now
constricts
• blood flow through the
lungs to pick up oxygen
AFTER BABY’S BIRTH

Lungs and Circulation After Delivery:

• pulmonary arterioles dilate
• pulmonary blood flow increases
NORMAL TRANSITION

The following 3 major changes take place within seconds after birth:
• alveolar fluid is absorbed
• umbilical arteries and vein constrict thus increasing blood pressure
• blood vessels in the lungs relax
WHAT CAN GO WRONG DURING
TRANSITION

• lack of ventilation of the newborn’s lungs  sustained constriction of the pulmonary

arterioles  prevents systemic arterial blood from being oxygenated
• prolonged lack of adequate perfusion and oxygenation  damage to brain damage,
damage to other organs, or death
SIGNS OF A COMPROMISED
NEWBORN

• poor muscle done

• depressed respiratory drive
good tone w/
• bradycardia cyanosis
• low blood pressure
• tachypnea
• cyanosis bad tone w/
cyanosis
IN UTERO OR PREINATAL
COMPROMISE

PRIMARY APNEA
• When a fetus / newborn first becomes deprived of oxygen, an initial period of attempted
rapid breathing occurs, followed by primary apnea with dropping of heart rate. This
improves with TACTILE STIMULATION.
IN UTERO OR PREINATAL
COMPROMISE

SECONDARY APNEA
• continued O2 deprivation  secondary apnea
+ continued fall in HR and BP
• secondary apnea cannot be reversed by
tactile stimulation; assisted ventilation must
be provided
IN UTERO OR PREINATAL
COMPROMISE

SECONDARY APNEA
• initiation of effective positive pressure ventilation during secondary apnea usually results
in:
• RAPID IMPROVEMENT IN HEART RATE
RESUSCITATION FLOW DIAGRAM:

INITIAL ASSESSMENT:
• determine if the baby can remain with the mother or should be moved to a radiant warmer
for further evaluation

AIRWAY
• perform the initial steps to establish an open airway and support spontaneous respiration
RESUSCITATION FLOW DIAGRAM:

BREATHING:
• positive pressure ventilation is provided to assist breathing for babies with apnea or
bradycardia
• other interventions (CPAP or oxygen) maybe appropriate if baby has labored breathing or
low oxygen saturation
RESUSCITATION FLOW DIAGRAM:

CIRCULATION:
• if severe bradycardia persists despite assisted ventilation, circulation is supported by
performing chest compressions, coordinated with PPV
DRUGS:
• if severe bradycardia persists despite assisted ventilation and coordinated chest
compressions, the drug EPINEPHRINE is administered as PPV and chest compressions
continue.
FOCUS ON TEAMWORK:

• poor teamwork and communication were the

most common root causes for potentially
preventable infant deaths in the delivery room

PRE-RESUSCITATION BRIEFING
• planning how the team will be contacted and
who will respond
• each team member needs to understand his
role and the tasks he or she will be assigned
PRE-RESUSCITATION BRIEFING:

• assess perinatal risk factors

• identify a team leader
• delegate tasks
• identify who will document events as they
occur
• determine what supplies and equipment will
be needed
• identify how to call for additional help
TEAM LEADER

• mastery of the resuscitation flow diagram

• effective leadership skills
• exemplify good communication skills
• sharing information
• delegating responsibilities
• maintaining a professional environment
• remain aware of the entire clinical situation
• maintaining a view of the big picture (not easily distracted by a single activity)
EFFECTIVE COMMUNICATION

• every team member shares responsibility for ongoing assessment

• share information: communicate with each other
• direct request to a specific individual
• call team member by name
• make eye contact
• speak clearly
• ask receiver to report back as soon as the task is completed.
ACCURATE DOCUMENTATION

• complete records are important for clinical decision making and source for quality
improvement data
• events during resuscitation documented as they occur; supplemented with retrospective
narrative summary
• use single time reference
• RECORDER should not be responsible for other roles (assigned to experienced team
member)
• use well designed forms that follow NRP / NRPh+ flow diagram: rapid data entry
POST-RESUSCITATION DEBRIEFING

• reinforces good teamwork habits and helps team identify areas of improvement
• quick debriefing immediately after the event; more comprehensive debriefing may be
scheduled afterward
• debriefings do not have to find major problems to be effective
• may identify series of small changes that result in significant improvements in your team’s
performance
“
Thank you!
”