Neonatal Resuscitation : Home, Birth Center, or Hospital Setting at Birth Neonatal Resuscitation Nicole Walters, MA
Nursing Student, Paramedic Student, & Midwife Apprentice
4 Million Infant Deaths/ Year : 4 Million Infant Deaths/ Year
Neonatal Deaths : Neonatal Deaths
Skills : Skills As a Midwife or Doula; NRP skills are a necessity
Recognize risk factors before birth
Be aware of birth environment during transition stage
Be prepared, have supplies readily available
Have members of birth team trained to know their roles
Remain calm
Supplies : Supplies O2 tank
O2 tubing
Neonate size Bag Valve Masks
Delee Suction Catheters
Warmed towels or Blankets
Extra Bulb Syringe
Roles of Birth Team : Roles of Birth Team Midwife: Lead, initiates NR
Midwife Assistant, Apprentice, or Doula:
obtain supplies, anticipate needed supplies, have area set-up for NR, call for back-up when needed
NRP : NRP
Causes/ Reactions : Causes/ Reactions Inadequate breathing hence lung fluid not absorbed
Meconium may block airway
Blood loss may occur
Persistence of constricted pulmonary vessels
Myocardium may be depressed
Organ systems may be affected by hypoxia/ischemia
Important Concepts : Important Concepts If a baby does not breathe immediately after being stimulated >>> secondary apnea
Assume every apneic baby is in secondary apnea
Longer the duration of compromise, longer it takes for recovery
Main Objective : Main Objective The most important and effective action is to ventilate the baby’s lungs enough to obtain chest rise and fall.
This ensures continued-adequate perfusion of tissue for life.
Initiating Neonatal Resuscitation : Initiating Neonatal Resuscitation Assessment
A -- Airway (position and suction)
B --Breathing (stimulate to cry)
C --Circulation (heart rate and color)
T --Temperature (warm and dry)
New guidelines (CAB)
Though Apgar score is important, it should not be used as a tool to determine need for NR
NRP : NRP The Neonatal Resuscitation flow diagram
NRP Skills 1 : NRP Skills 1 Directly at birth
Assessment:
Was the transition stage extended?
Is the amniotic fluid clear?
Is the baby breathing?
Is the baby crying?
Is the baby’s muscle tone good?
Is the baby’s color good?
NRP Skills 2 : NRP Skills 2 Birth to 30 seconds after birth
Provide warmth
Vigorously dry baby to stimulate
Position baby on flat surface
Assess color
Clear airway if needed
Wipe, Suction if needed
Reposition baby, football hold face up and football hold face down (head lower than body though, to help fluids naturally drain)
Reassess Respirations and HR
NRP Skills 3 : NRP Skills 3 3o minutes to 1 minute after Birth
If Respirations are still absent or faint proceed
Give positive pressure O2
Reassess
Give positive pressure O2
Give chest compressions
Reassess
(If MD, CNM, NP, RN, EMT present then medication and intubation may be considered interventions: ET tube, IV, Blood Volume, and Epinephrine)
NRP Skills 4 : NRP Skills 4 Post Neonatal Resuscitation
Continue O2 as needed, possibly as blow-by only
Reassess
If in home or birth center setting, call EMS if needed for transport to hospital setting