Newborn Resuscitation Rules Essay
Neonatal Resuscitation is intervention after a baby is born to help it breathe and to help its heart beat.
- Before a baby is born, the placenta provides oxygen and nutrition to the blood and removes carbon dioxide.
- After a baby is born, the lungs provide oxygen to the blood and remove carbon dioxide.Newborn Resuscitation Rules Essay
- The transition from using the placenta to using the lungs for gas exchange begins when the umbilical cord is clamped or tied off, and the baby has its first breath.
- Many babies go through this transition without needing intervention.
- Some babies need help with establishing their air flow, breathing, or circulation.
- Resuscitation is helping with Airway, Breathing, and Circulation, also known as the ABCs.Newborn Resuscitation Rules Essay
- The transition from using the placenta to using the lungs for gas exchange begins when the umbilical cord is clamped or tied off, and the baby has its first breath.
The first few moments of a newborn’s life can be the most critical. If needed, effective emergency care during this transition can prevent lifelong consequences. Proper resuscitation requires essential equipment and knowledge of necessary protocols before delivery. Prior knowledge of the gestational age of the newborn is helpful in anticipating the need for resuscitation. Low birth weight and premature delivery predispose infants to the need for resuscitative efforts.
A young, first-time mother delivers a baby at 38 weeks gestation. Her pregnancy was uncomplicated, Group B Strep was negative, and amniotic fluid was clear with no signs of meconium. Upon delivery, the baby appears white, apneic, limp and is not breathing or crying. The newborn is brought to the radiant warmer, where heart rate is noted to be 70 beats per minute. Positive pressure ventilation is provided with a mask and heart rate begins to steadily increase until it reaches 110 beats per minute. The baby’s oxygen saturation also falls within the target range for age. After stabilization, the baby is given to his mother for initiation of skin to skin contact while a nurse continues to monitor the baby’s vitals per protocol.Newborn Resuscitation Rules Essay
Definition
Neonatal Resuscitation is a set of interventions used to assist the airway, breathing and circulation of a newborn following birth. The Neonatal Resuscitation Program (NRP) is a set of educational guidelines established by the American Academy of Pediatrics that outline the proper procedures for resuscitation of a newborn. Many medical professionals, especially those dealing directly with newborns are required to complete the educational program and become certified so that they may properly respond in the event of an emergency.
Prior to birth, oxygen and nutrients are provided to the baby by way of the placenta. Once a baby is born, he must rapidly transition to extra uterine life and be able to sustain himself without support from the mother. Sometimes, babies have difficulty making this transition, and it is almost always due to a respiratory related issue. Some of these babies need a small amount of help and will not require much intervention. Others will be in so much respiratory distress that it begins to affect their cardiovascular system and they will need a full resuscitation. The main difference in resuscitation of a newborn as opposed to an adult is that in an unstable newborn, the problem is almost always respiratory related. Most infants are not born with cardiovascular issues. However, a delay in treatment of respiratory distress may begin to affect the cardiovascular system. It is important to remember that in most cases, fixing the respiratory issue will also resolve the cardiovascular issue when dealing with neonates.Newborn Resuscitation Rules Essay
Steps
Assessment
As in any resuscitation, the first step is always assessment. Some important questions to consider are: ”Does the baby appear to be of term gestation? Does he have good muscle tone? Is he breathing or crying?” This is considered your initial assessment. If the answer to any of these questions is no, you should continue to assess and intervene as necessary.
While bringing the newborn to the radiant warmer, have an assistant start the timer to begin counting number of minutes after birth. This will be important to our assessments later on. While the baby is on the warmer, attach a pulse oximeter to his right wrist, as this is the best place to measure oxygen saturation on a newborn. This will also allow us to monitor the baby’s heart rate. Depending on the number of minutes after birth, the oxygen saturation should fall within certain parameters. Below is a table demonstrating proper oxygen saturation levels for newborns depending on their age.Newborn Resuscitation Rules Essay
Interventions
After assessment of the newborn, it is important to know when to intervene. As a rule of thumb, a heart rate less that 100 beats per minute requires respiratory support. This will come by way of a mask that should be held securely over the infants mouth and nose. Providing positive pressure ventilation (PPV) or intermittent rescue breaths will assist in keeping the airway of the baby open and may help to initiate breathing. Any heart rate below 100 beats per minute indicates a reason to initiate PPV.
If the newborn’s heart rate is below 60 beats per minute, the first step is still to initiate PPV. If PPV is not effective in bringing the heart rate up, you should then troubleshoot by using the acronym MR SOPA.Newborn Resuscitation Rules Essay
neonatal resuscitation
Patient care
The cornerstone of neonatal resuscitation is the prompt recognition of the newborn who is failing to breathe and per fuse organs effectively. Immediately after birth, the newborn should be dried, gently suctioned, and assessed for: adequate respiratory effort (versus apnea); a heart rate above 100 beats/min; good muscle tone (as opposed to flaccidity); skin color that indicates effective cardiac output (rather than cyanosis); and evidence of full-term versus pre-term birth.Newborn Resuscitation Rules Essay
The neonate who lacks some of these findings should be professionally managed, with warming, gentle stimulation (e.g., rubbing its back gently with a towel to stimulate effective breathing) and airway suctioning. When apnea, hypothermia, respiratory distress, bradycardia, or poor skin perfusion is evident, evidenced-based interventions (e.g., those recommended by the Neonatal Resuscitation Program of the American Academy of Pediatrics and the AHA) should be begun immediately.
Positive-pressure ventilation (PPV), with breaths supplied via a bag mask device, effectively resuscitates most infants at risk for neonatal asphyxia. Those who have meconium in the upper airways (evidenced by meconium staining of the amniotic fluid), as well as inadequate breathing, slow heart rate, and poor muscle tone, require endotracheal intubation and suctioning, preferably by an experienced practitioner.
Most neonates respond favorably to airway and ventilatory management, breathe spontaneously, and maintain a heart rate above 100 beats/min. Chest compressions should be begun only if the heart rate remains below 60 beats/min despite 30 sec of PPV with 100% oxygen. Chest compressions should cease when the heart rate is above 60 beats/min, but PPV should be continued until the heart rate is above 100 beats/min and the newborn has begun to breathe on his own. PPV should always accompany chest compressions and be coordinated so that a breath is provided after every third compression. After 30 sec of PPV and chest compressions, the compressions should be stopped and the heart rate evaluated while PPV is continued. If there is no palpable pulse at the base of the umbilical cord, PPV should be stopped and the chest auscultated to determine the heart rate.Newborn Resuscitation Rules Essay
Chest compressions are most effective when the sternum is depressed to a depth equal to one third of the anteroposterior chest diameter of the newborn. The preferred technique is to use the thumbs to depress the sternum, with the hands encircling the newborn’s thorax. An alternative is to perform compressions with two fingers on the same hand, so that the umbilical vein can be cannulated by another resuscitator. Ninety compressions a minute should be coordinated with 30 positive-pressure breaths, with care taken to avoid simultaneous compressions and ventilation’s.
Access to the circulation can be gained through the umbilical vein or intravenously into the tibia. Normal saline or lactated Ringer’s solution is the preferred fluid. Narcotic antidotes should be given to reverse any depression in respiratory or neurological status from maternal narcotic overdose. Inotropes such as epinephrine should be used when ventilation and chest compressions do not revive the dying infant.Newborn Resuscitation Rules Essay
In prolonged resuscitation’s, blood gases should be drawn to help guide additional therapies.
Resuscitation interventions that have not proved to be helpful include the use of high-dose epinephrine, the induction of cerebral hypothermia, and the use of carbon dioxide detectors on the endotracheal tube.
Resuscitation should not be initiated for children born with severe anomalies incompatible with life, e.g., anencephaly or birth weights of less than 400 g. Resuscitation efforts that do not resolve apnea and purposelessness after more than 10 min are rarely successful in newborns. In these circumstances, efforts may be discontinued.
The adaptation from intrauterine to extrauterine life involves a complex and rapid orchestration of physiologic changes. Within minutes of life, the newly born infant is subjected to multiple unfamiliar stimuli such as cold, light, and noise compared with the warm, dark environment of intrauterine life. In addition, the infant must make the transition from dependence on placental gas exchange to spontaneous air breathing and pulmonary gas exchange. Most often, this transition occurs without difficulty. However, multiple maternal, placental, mechanical, and fetal conditions exist that can jeopardize a smooth transition and signal the need for intervention. It is estimated that 5% to 10% of newly born infants will require some degree of active resuscitation for this transition to occur.1 Thus, an individual trained in neonatal resuscitation must be in attendance at every delivery. Furthermore, it is essential that these skilled personnel understand transitional physiology and the basic principles of resuscitation to intervene rapidly when needed in an attempt to prevent any long-term adverse sequelae. The purpose of this chapter is to discuss the physiology of the birth process and the basic approaches to neonatal resuscitation.Newborn Resuscitation Rules Essay
FETAL PHYSIOLOGY
The fetal environment is drastically different from that of the newly born infant. The fluid-filled amniotic sac creates a warm, cushioned space for the fetus. Fetal lung fluid, which is constantly secreted by the lung epithelium into the alveolar spaces,2 is crucial for fetal lung growth.3 This fetal lung fluid at term gestation is equivalent to the functional residual capacity of the newborn lung or 20 to 25 mL/kg. Fetal breathing actively propels this fluid out of the lungs,4 thus contributing to the amniotic fluid. Fetal respiration’s are also thought to strengthen the diaphragm and intercontinental muscles in preparation for birth. During gestation, the placenta is the organ of gas exchange. However, after birth, the respiratory muscles take over the work of breathing and the lungs assume the responsibility of gas exchange and oxygenation.5
Fetal blood is relatively hypoxemic. The highest Pao2 is about 30 to 35 mm Hg, with an oxyhemoglobin saturation of approximately 75% to 85%. Yet, this level is adequate for fetal tissue oxygenation and growth owing to some compensatory mechanisms. First of all, oxygen consumption is lower in the fetus compared with that of the newly born infant. Second, the fetus has an increased red cell mass. Third, fetal hemoglobin has an increased affinity for oxygen.
Fetal circulation is unique because the placenta is wholly responsible for respiration, nutrition, metabolism, and excretion. Oxygenated blood with the highest Pao2 therefore moves from the placenta through the umbilical vein to the fetus. From the umbilical vein, blood then flows through the ductus venosus into the inferior vena cava and subsequently into the right atrium. Approximately two thirds of this blood is shunted across the foramen ovale into the left atrium. This shunting occurs because the left atrial pressure is lower than that of the right atrium in the fetus. From the left atrium, the blood enters the left ventricle and subsequently the systemic circulation. The coronary and cerebral vessels arise directly off the aorta and thus are bathed with the best oxygenated blood available to the fetus.5Newborn Resuscitation Rules Essay