Aims of Management.

The goals of managing a newborn requiring resuscitation are:

• To initiate and/or restore respiration /breathing: The primary objective is to help the baby begin breathing or to re-establish effective breathing.

• To prevent infection: Minimizing the risk of infection in the vulnerable newborn period.

• To prevent other complications: Taking steps to avoid potential health issues that can arise during or after resuscitation.

• To Prevent hypothermia: Ensuring the baby stays warm, as temperature regulation is crucial.

Requirements

The following equipment and supplies are typically needed for newborn resuscitation:

• A pair of surgical gloves: To maintain sterility and protect both the caregiver and the infant.

• Warm baby’s clothes: To dress the baby after stabilization and maintain body temperature.

• Suction device: Such as a bulb syringe, to clear the airway of fluids.

• Ventilation bag and mask (ambu bag): Used to provide assisted ventilation if the baby is not breathing adequately.

• Endotracheal tube: A tube inserted into the trachea to deliver oxygen directly to the lungs. Size typically 1mm for full-term infants or 0.5mm for preterm babies.

• Laryngoscope: An instrument used to visualize the vocal cords during endotracheal intubation.

• Nasal gastric tube: May be needed to decompress the stomach.

• 3 Gallipots: Small, kidney-shaped dishes to hold fluids or small items.

• 3 Receivers: Containers to collect waste or fluids.

• Mothers chart: To record important maternal and birth information.

• Tray containing a gallipot of wet swab, syringes: For cleaning and medication administration.

• Pediatric stethoscope: To listen to the baby’s heart and lungs.

• Strapping: To secure the endotracheal tube if needed.

• Naso prongs (oxygen catheters): Small tubes placed in the nostrils to deliver supplemental oxygen.

Drugs

Medications that may be required during newborn resuscitation include:

• Naloxone hydrochloride 1mg ampoule 400mg/1ml: An opioid antagonist used to reverse respiratory depression caused by maternal opioid use.

• Adrenaline (Epinephrine) 1:1000: A medication used to stimulate the heart and increase blood flow.

• Normal saline 0.9%: An isotonic intravenous fluid for volume replacement.

• Ringers lactate: Another isotonic intravenous fluid containing electrolytes.

• Sodium bicarbonate 4.2%: Used to correct metabolic acidosis in certain situations.

• Dextrose 10%: A glucose solution given intravenously to treat hypoglycemia.

• Vitamin K: Administered to prevent bleeding.

• Sterile water: For mixing medications or for rinsing.

Bed side

Essential equipment to have readily available at the bedside includes:

• Resuscitation table: A firm, flat surface for performing resuscitation.

• Timer (clock watch): To accurately time interventions and assess the baby’s condition.

• Light source: To provide adequate illumination for procedures.

• Oxygen source: A reliable supply of oxygen.

• Displayed chats for steps: Visual aids outlining the steps of newborn resuscitation.

Principles of Management.

The fundamental principles guiding newborn resuscitation are:

• Temperature regulation: Maintaining adequate warmth is crucial to prevent hypothermia. Hypothermia can lead to a decreased metabolic rate, adding stress to the newborn.

• Ensure adequate oxygenation: Providing sufficient oxygen is vital to prevent hypoxia. This involves administering oxygen and monitoring oxygen perfusion. An endotracheal tube may be necessary to deliver oxygen directly.

• Prevention of hypoglycemia: Regularly monitoring blood glucose levels is important. If a risk of hypoglycemia is identified, dextrose should be administered as prescribed.

Steps for Resuscitation

The sequence of actions in newborn resuscitation can be remembered by the acronym TABCs.

STEP 1

• Dry the baby, wipe the baby’s mouth with gauze and remove any wet cloth: This helps to prevent heat loss and clear the airway.

STEP 2

• Clear the air way: Ensuring a clear passage for air is essential.

  • Suck blood or mucus from mouth using a bulb syringe or mucus extractor: Gently remove any obstructions from the mouth and nose.

  • Position baby’s head in a neutral position with head extended: This “sniffing” position helps to open the airway.

  • Place a small towel under the shoulders to maintain the position: This provides support and keeps the head slightly extended.

  • infant resuscitation: This step focuses on establishing an open airway.

STEP 3

• Support breathing: If the baby is not breathing or is gasping, assisted ventilation is needed.

  • Stand at the baby`s head, apply ambu-bag and a small mask to the baby’s face ensuring that the mask covers the face and mouth to form a seal: A proper seal is necessary for effective ventilation.

  • Give five inflation breaths (each 2-3seconds duration): These initial breaths help to open the lungs.

  • Observe response by looking at the chest movements (chest rising) or increase in the heart rate: Effective ventilation will cause the chest to rise. An increase in heart rate is another positive sign.

  • (if chest does not rise then reapply mask, reposition baby’s head, and suction.): If the chest is not rising, troubleshoot the mask seal, head position, and check for airway obstructions.

  • Continue ventilating at a rate of 30-40 breathes for a minute: Maintain this rate to provide adequate respiratory support.

• Circulation/External Cardiac Massage: Chest compressions are necessary if the heart rate is dangerously low.

  • Chest compression should be performed when the heart rate is less than 100b/m and falling inspite adequate ventilation: This indicates the need for circulatory support.

  • If no heart beats are recorded after one minute, do external compressions: Immediate action is required if there is no heartbeat.

  • Wrap your palms around the baby`s chest, placing the thumbs / first finger over the lower part of the sternum: This describes the two-thumb encircling technique.

  • Chest is compressed at rate of 100–120 times 1 minute at a ratio of 3 compressions to one ventilation: Maintain this coordinated rhythm of compressions and breaths.

  • Use the thumb to gently compress the chest, depressing it ½ to ¾ inch each time: Apply adequate depth of compression.

  • If in 20 minutes the breathing is not established. Consider intubation: Prolonged lack of spontaneous breathing may necessitate securing the airway with an endotracheal tube.

  • When the infant has no spontaneous breathing then continuous positive pressure ventilation (CPPV) should be started with bag and mask: Providing consistent pressure to keep the airways open.

  • The rate of chest compressions in one minute should be 90 along with 30 PPVs, (3:1), a total of 120 events: This emphasizes the coordination of compressions and positive pressure ventilations.

  • If the heart rate is <60, despite of effective ventilation, chest compression and two intravenous doses of adrenaline (Epinephrine), the sodium bicarbonate 4.2% solution (0.5mmol/ml) can be administered using 2–4ml / kg (1-2mmol/ml) by slow intravenous: This outlines the use of sodium bicarbonate for persistent bradycardia despite other interventions.