New -Born Resuscitation

Subject: Midwifery II (Theory)

Overview

Newborns with intrapartum indications of considerable fetal impairment, babies delivering before 35 weeks gestation, babies delivering vaginally via the breech, maternal infection, and multiple pregnancies are more likely to require resuscitation or transition care. The steps for doing neonatal resuscitation are to first position the baby, then clear the airway, and then ventilate the baby. Ventilate once or twice, keeping an eye on the baby's chest to see if it rises. If the chest does not rise with each breath, check the baby's position, reposition the baby, your mouth, or the mask, and try again until it does. After that, keep an eye on a newborn who has undergone resuscitation or has poor color, even if he appears to be breathing normally.

Newborns with intrapartum indications of considerable fetal impairment, babies delivering before 35 weeks gestation, babies delivering vaginally via the breech, maternal infection, and multiple pregnancies are more likely to require resuscitation or transition care.

Furthermore, cesarean delivery is related to an increased risk of issues with the respiratory transition at birth that necessitates medical intervention, particularly for deliveries before 39 weeks gestation.

Newborn life support (NLS) is designed to provide this assistance and consists of the following components:

  • Delaying the clamping of the umbilical cord allows for placental transfusion.
  • Drying and covering the newborn infant, as well as taking any additional procedures necessary to maintain a normal body temperature (between 36.5°C and 37.5°C).
    determining the infant's condition and the necessity of any action
  • Keeping an open airway.
  • If the infant is not breathing, use inflation breaths to aerate the lungs.
  • Continue to ventilate apnoeic newborns until breathing is restored.
  • Start chest compressions if the heart rate remains less than 60 minutes after 5 effective inflation breaths and 30 seconds of effective ventilation.

Steps of Newborn Resuscitation

Step 1: Position the Baby

  • Place the infant on a flat surface on his back.
  • Place the head in such a way that the neck is slightly stretched. To keep the position, place a rolled cloth beneath the shoulder.
  • The surface of resuscitation should be well-lit and warm.
  • To keep the baby warm, cover his head and lower torso.

Step 2: Clear the Airway

  • Wipe the baby's face clean with clean gauze or cloth.
  • Suction the infant.
  • Bulb suction is an option.
  • After use, throw away the bulb syringe.
  • Suction with a De Lee suction device or a mucus extractor.
  • A clean soft suction tube or catheter size 12 F can be utilized with machine suction.
  • Suction the baby's mouth first, then his nose.
  • Suction tubes should not be inserted more than 5 cm into the mouth and 3cm into the nose.
  • After positioning the baby and clearing the airway, quickly reassess the breathing.
  • If the baby is breathing normally, no more resuscitation measures are required.
  • Begin ventilation if a baby is having difficulties breathing or is not breathing.

Step 3: Ventilate

Ventilate once or twice, keeping an eye on the baby's chest to see if it rises. If the chest does not rise with each breath, check the baby's position, reposition the baby, your mouth, or the mask, and try again until it does. Repeat suctioning as necessary.

  • In 1 minute, take 40 deep breaths.
  • Stop after 1 minute to see if the infant begins to breathe independently.
  • Continue to ventilate the baby until he or she spontaneously cries or breathes.
  • When the baby's breathing is normal, the following issues arise:
    - discontinue ventilation and continue to constantly watch the baby.
  • Stop ventilation if there is no breathing or gasping after 20 minutes. The infant has perished.

Step 4: Monitor

  • Monitor a baby who has had resuscitation or has poor color, even if he appears to be breathing OK.
  • Problems to look out for include grunting, chest indrawing, fast breathing, slow breathing, and pale skin. Give oxygen to a baby who is having trouble breathing.
  • Maintain the baby's warmth and dryness.
  • If the baby's condition worsens. Transfer to a hospital for medical treatment as soon as possible.

Post-resuscitation care

  • Therapeutic Hypothermia
    Therapeutic hypothermia should be used in term or near-term newborns with moderate to severe hypoxic-ischemic encephalopathy. Both whole-body cooling and selective head cooling are viable options. Cooling should be commenced and carried out according to well-defined protocols, with treatment in neonatal critical care units and the ability to provide multidisciplinary care.
     
  • Glucose
    Infants who are premature or require extensive resuscitation should be examined and treated to keep blood glucose levels within the normal range. An infusion of 10% glucose, rather than repeated boluses, is usually the most effective at treating low blood glucose levels and keeping them in the normal range.
     
  • Resuscitation or stabilisation
    Most term newborns do not require resuscitation and can usually stabilize themselves fairly well during the shift from placental to pulmonary breathing. Intervention is rarely required if care is taken to limit heat loss (and avoid over-warming) and a little patience is displayed before cutting the umbilical cord. Some infants, however, will have been subjected to stress or insults during labor. Help may then be necessary, which is defined by interventions aimed to save a sick or very unwell infant, and this procedure is appropriately referred to as resuscitation.
     
  • Umbilical cord clamping
    Delaying cord clamping for at least one minute or until the cord stops pulsing following delivery increases iron status into early infancy in healthy term newborns. Delaying cord clamping for up to 3 minutes for preterm infants in good health at birth leads to improved blood pressure during stabilization, a decreased incidence of intraventricular hemorrhage, and fewer blood transfusions.
     
  • Maintaining normal temperature (between 36.5°C and 37.5°C)
    In an environment that is comfortably warm for humans, naked, damp newborn infants cannot regulate their body temperature. Infants with impaired immune systems are more prone to the effects of cold stress, which can reduce arterial oxygen tension and exacerbate metabolic acidosis. To avoid hypothermia, active steps must be taken, especially in the preterm infant, where a team approach and a combination of methods may be required.

 References
Things to remember
  • Newborns with intrapartum indications of considerable fetal impairment, babies delivering before 35 weeks gestation, babies delivering vaginally via the breech, maternal infection, and multiple pregnancies are more likely to require resuscitation or transition care.
  • Furthermore, cesarean delivery is related to an increased risk of issues with the respiratory transition at birth that necessitates medical intervention, particularly for deliveries before 39 weeks gestation.
  • The steps for doing neonatal resuscitation are to first position the baby, then clear the airway, and then ventilate the baby.
  • Ventilate once or twice, keeping an eye on the baby's chest to see if it rises.
  • If the chest does not rise, examine the infant's position, reposition the baby, your mouth, or the mask, and try again until the chest rises optimally.
  • After that, keep an eye on a newborn who has undergone resuscitation or has poor color, even if he appears to be breathing normally.
Questions and Answers

Babies who have intrapartum evidence of significant fetal compromise, babies who deliver before 35 weeks gestation, babies who deliver vaginally by the breech, maternal infection, and multiple pregnancies are more likely to require resuscitation or support of transition.

Post-resuscitation Care

Therapeutic Hypothermia

Term or near-term infants, with evolving moderate to severe hypoxic-ischaemic encephalopathy, should be treated with therapeutic hypothermia. Whole body cooling and selective head cooling are both appropriate strategies. Cooling should be initiated and conducted under clearly-defined protocols with treatment in neonatal intensive care facilities and the capabilities for multidisciplinary care.

Glucose

Infants who are preterm or require significant resuscitation should be monitored and treated to maintain blood glucose in the normal range. An infusion of 10% glucose rather than repeated boluses is usually best at treating low blood glucose values and maintaining glucose in the normal range.

Resuscitation or Stabilisation

The majority of infants delivered at term do not require cardiopulmonary resuscitation, and they can typically stabilize themselves during the very effective switch from placental to pulmonary respiration.

Intervention is rarely required as long as heat loss is prevented (and overheating is avoided) and a little patience is shown before cutting the umbilical cord. However, some newborns may have experienced insults or stresses during labor. Resuscitation is a term that can be used to describe the process of providing assistance when it is necessary to save a sick or critically ill infant.

Umbilical Cord Clamping

Delaying cord clamping after delivery for at least one minute or until the cord stops pulsing in healthy term infants improves iron status through early infancy. Delaying cord clamping for up to 3 minutes for preterm infants in good condition at delivery leads to higher blood pressure during stabilization, a lower incidence of intraventricular hemorrhage, and fewer blood transfusions.

Maintaining Normal Temperature (between 36.5°C and 37.5°C)

A room that is comfortably warm for adults is inhospitable to naked, wet, newborn infants who are trying to regulate their body temperatures. Cold stress can have negative effects on infants who are already weak, such as lowering arterial oxygen tension and causing more metabolic acidosis. To prevent hypothermia, proactive measures will need to be taken, especially in preterm infants where a team approach and combination of strategies may be necessary.

Steps of Doing Newborn Resuscitation

  • Step 1: Position the baby
    • Place the baby on his back on a flat surface.
    • Position the head so that the neck is slightly extended. You may put a rolled cloth under the shoulder to maintain the position.
    • The resuscitation surface should be well lit and warm.
    • Keep the baby's head and lower body covered to keep him warm.
  • Step 2 : Clear the Airway
    • Wipe off the baby's face with a clean piece of gauze or cloth.
    • Suction the baby.
    • Bulb suction may be used.discard the bulb syringe after use.
    • Mechanical suction with a De Lee type suction device or mucus extractor.
    • Machine suction can be used with a clean soft suction tube or catheter size 12 F.
    • Always suction the baby's mouth first and then the nose.
    • Do not insert a suction tube more than 5 cm into mouth and 3cm into the nose.
    • Quickly reassess the breathing after you have positioned the baby and cleared the airway.
    • If the baby is breathing without difficulty, no further resuscitation steps are needed.
    • If a baby is having breathing difficulty or is not breathing, begin ventilation.
  • Step 3 : Ventilate
    • Ventilate once or twice , watching to see if the baby's chest rises. If the chest does not rise, check the baby's position, reposition the baby, your mouth or the mask and try again until you get the best to rise with each breath. If necessary repeat suctioning.
    • Ventilate about 40 times in 1 min.
    • After 1 min, stop to see if the babu starts o breath independently.
    • Continue ventilation until the baby spontaneous cries or breath.

When baby breathing is normal,stop ventilation and continue to monitor the baby closely.

If there is not breathing or gasping after 20 mins, stop ventilation. The baby has died.

  • Step 4 : Monitor
    • Closely monitor a baby who had resuscitation or who has poor color, even if he appears to be breathing well.
    • Watch for breathing problems : grunting, indrawing of a chest, rapid breathing, slow breathing, pale color. If a baby is having difficulty in breathing give oxygen.
    • Keep the baby warm and dry.
    • If the Baby condition deteriorates . transfer rapidly to a hospital for medical care.

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