Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword (1)
- Foreword (2)
- Preface
- Acknowledgments
- Section 1 Organization of neonatal transport
- Section 2 Basics in cardiopulmonary resuscitation of newborn infants
- Basic equipment setup for initial neonatal care and resuscitation
- Drugs for neonatal emergencies
- Postnatal cardiopulmonary adaptation
- ABC Techniques and Procedures
- Sunctioning
- Stimulation, oxygen supplementation, bag-and-mask ventilation (M-PPV), pharyngeal/bi-nasal CPAP, and pharyngeal positive pressure ventilation
- Endotracheal intubation and gastric tube placement
- Laryngeal mask airway (LMA)
- Chest compressions
- Peripheral venous access
- Umbilical vein/artery catheterization (UVC, UAC)
- Central venous access (internal jugular vein)
- Intraosseous access
- Cord clamping
- Management of high-risk infants in the delivery room
- Monitoring in the delivery room and during neonatal transport
- Hygiene in the delivery room and during neonatal transport (infection control)
- When to call a pediatrician to the delivery room
- Checklist for the postnatal treatment of newborn infants
- Assigning individual duties in the delivery room
- Clinical assessment of the newborn infant
- Cardiopulmonary resuscitation of newborn infants at birth
- Volume therapy and sodium bicarbonate supplementation in preterm and term newborn infants
- Absolute and relative indications for neonatal transport and NICU admission
- Communication with mother and father
- Coordinating neonatal transport and patient sign-out to the NICU team
- Documentation and feedback after neonatal emergency transport
- Ethics in neonatal intensive care
- Perinatal images of preterm and term infants
- Mechanical ventilation of the neonate
- Questions for review (basics)
- References (Section 2)
- Section 3 Classic and rare scenarios in the neonatal period
- Section 4 Transport
- Section 5 Appendix
- Index
- Plate section
Stimulation, oxygen supplementation, bag-and-mask ventilation (M-PPV), pharyngeal/bi-nasal CPAP, and pharyngeal positive pressure ventilation
from Section 2 - Basics in cardiopulmonary resuscitation of newborn infants
Published online by Cambridge University Press: 05 March 2012
- Frontmatter
- Contents
- List of contributors
- Foreword (1)
- Foreword (2)
- Preface
- Acknowledgments
- Section 1 Organization of neonatal transport
- Section 2 Basics in cardiopulmonary resuscitation of newborn infants
- Basic equipment setup for initial neonatal care and resuscitation
- Drugs for neonatal emergencies
- Postnatal cardiopulmonary adaptation
- ABC Techniques and Procedures
- Sunctioning
- Stimulation, oxygen supplementation, bag-and-mask ventilation (M-PPV), pharyngeal/bi-nasal CPAP, and pharyngeal positive pressure ventilation
- Endotracheal intubation and gastric tube placement
- Laryngeal mask airway (LMA)
- Chest compressions
- Peripheral venous access
- Umbilical vein/artery catheterization (UVC, UAC)
- Central venous access (internal jugular vein)
- Intraosseous access
- Cord clamping
- Management of high-risk infants in the delivery room
- Monitoring in the delivery room and during neonatal transport
- Hygiene in the delivery room and during neonatal transport (infection control)
- When to call a pediatrician to the delivery room
- Checklist for the postnatal treatment of newborn infants
- Assigning individual duties in the delivery room
- Clinical assessment of the newborn infant
- Cardiopulmonary resuscitation of newborn infants at birth
- Volume therapy and sodium bicarbonate supplementation in preterm and term newborn infants
- Absolute and relative indications for neonatal transport and NICU admission
- Communication with mother and father
- Coordinating neonatal transport and patient sign-out to the NICU team
- Documentation and feedback after neonatal emergency transport
- Ethics in neonatal intensive care
- Perinatal images of preterm and term infants
- Mechanical ventilation of the neonate
- Questions for review (basics)
- References (Section 2)
- Section 3 Classic and rare scenarios in the neonatal period
- Section 4 Transport
- Section 5 Appendix
- Index
- Plate section
Summary
Rapid initial assessment (0–30 s after birth) and stimulation
After birth, assessment of breathing and heart rate is done rapidly (see p. 131, pp. 142–9, pp. 150–3), as follows:
Palpate the umbilical cord or auscultate the heart: HR >100 bpm? Assistant may tap out HR for other resuscitators
Is meconium visible? (Check in particular for staining of cord stump and nail beds)
Suction (first mouth, then nose), if needed (see pp. 66–9)
Dry and thereby stimulate breathing/keep warm (certain exceptions may apply)
If still pale/cyanotic/insufficient breathing, proceed to stimulation (with four fingers while drying the back, may also rub the soles of the feet and sternum)
O2 supplementation as needed if SpO2 <85%–90% (FiO2 0.21–1.0, flow 5 1/min)
If there are signs of severe neonatal compromise/terminal (aka: secondary) apnea present, perform PPV (see below)
Oxygen supplementation
Postnatally administered oxygen (via hood, mask, phargngeal-CPAP, intubation/PPV) is a very effective “drug” (oxygen decreases PVR, increases pulmonary blood flow and oxygenation, and induces ductus constriction).
! If the SpO2 is rapidly improving during initial newborn care, oxygen supplementation must be continuously reduced or stopped, since high PaO2 levels/oxygen radicals reduce cerebral blood flow, induce myocardial and renal tubular damage, and promote the development of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) in preterm infants.
! In most cases, there is no need to provide a newly born infant with additional oxygen in the delivery room if preductal SpO2 is reliably >85%–90% (i.e., no meconium aspiration, sepsis/pneumonia, CDH or other causes of impaired lung function and PPHN).
At 5 min of life, approximately half of newborns in room air have SaO2 of 90%. […]
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- Information
- Neonatal Emergencies , pp. 71 - 81Publisher: Cambridge University PressPrint publication year: 2009