NEONATAL RESUSCITATION PROGRAM- NRP 5 INITIAL STEPS OF NEWBORN CARE 1. Provide warmth 2. Position head and neck to open airway 3. Clear secretions if necessary 4. Dry baby 5. Stimulate **Establishing Effective Ventilation of the baby’s lungs is the MOST IMPORTANT and effective action during resuscitation 4 QUESTIONS TO ASK BEFORE EVERY BIRTH 1. What is expected gestational age 2. Is the amniotic fluid clear 3. How many babies are expected 4. Are there any additional risk factors RAPID EVALUATION FOR ALL NEWBORNS IS REQUIRED—ASK IF THE BABY IS: 1. Term? 2. Tone? (Healthy babies should be active and flex extremities) 3. Breathing/Crying? (Gasping is a sign of severely impaired gas exchange)
**If the answer is NO to any of these, the newborn should be brought to the radiant warmer for the initial steps of newborn care Fetal lungs do not participate in gas exchange but are expanded—alveoli is filled with fluid, NOT air but are still expanded—pulmonary vessels are tightly constricted Oxygenated fetal blood leaves placenta through umbilical vein—there is 1 vein, 2 arteries in the umbilicus Opening in atrium is a Patent Foramen Ovale-most blood bypasses lungs through the foramen OR flows from pulmonary artery into aorta through ductus arteriosis Right to left shunting is when blood follows a circulation path and bypasses the lungs Oligohydramnios- deficiency of amniotic fluid Polyhydramnios- excessive amniotic fluid Fetal hydrops- serious condition defined as abnormal accumulation of fluid in 2 or more compartments including ascites, pleural effusion, pericardial effusion, and skin edema
Chorioamnionitis- inflammation of the fetal membranes (amnion and chorion) due to a bacterial infectionBacteria ascends from the vagina into the uterus usually caused by prolonged labor Newborns usually require resuscitation because of a problem with respiration leading to inadequate gas exchange -Fetal respiration is performed by the placenta -When placental respirations fail, the fetus receives an insufficient supply of O2 to support cellular function and CO2 cannot be removed Babies temp should be maintained between 36.5-37.5C (97.7-99.5F) during resuscitation Place baby supine with head and neck in the sniffing position (do not hyperextend or flex-chin to chest) Clear secretions if baby is not breathing, gasping or has poor tone or meconium stained fluid Suction mouth THEN nose *Remember M before N -can use bulb syringe -if using suction, catheter, set to 80-100 mmHg Dry baby if wet-discard wet towels If baby is less than 32 weeks, wrap in polyethylene plastic
Can gently stimulate baby by rubbing back, trunk or extremities—Don't’ over stimulate—Can cause injury If newborn remains apneic, begin PPV (positive pressure ventilation)- 21% Oxygen **NRP recommends that resuscitation of the baby 32 weeks and greater is initiated with 21% oxygen. If baby doesn’t have spontaneous respirations and a heart rate of 100bpm or higher within 1 minute of birth, begin PPV HR should be at least 100bpm—auscultation along the left side of the chest is the most accurate to determine HR -Palpation at the umbilical cord base may be felt but is less accurate and may underestimate the true HR -Using a stethoscope, estimate the HR by counting the number of beats in 6 seconds and multiply by 10 ie. 6 seconds x 12 beats= 120bpm If HR cannot be determined, connect ECG and/or Pulse Ox—pulse ox may not function is HR is too low or baby has low perfusion so ECG would be preferred method
After The Initial Steps Listed Above, What To Do If The Baby Is Not Breathing Or HR Is Low: Start PPV if baby is not breathing (apnea) OR if the baby has gasping respirations Start PPV if the baby appears to be breathing, but the HR is below 100bpm Call for help if alone at the warmers If the baby has not responded to the initial steps within the first minute of life, it is NOT appropriate to continue to provide only tactile stimulation What Do You Do If The Baby Is Breathing And The Heart Rate Is At Least 100bpm, But The Baby Appears Persistently Cyanotic? **Apply a pulse oximeter** Indications to apply a pulse oximeter: When resuscitation is anticipated To confirm your perception of persistent central cyanosis When supplemental oxygen is administered When positive-pressure ventilation is required Acrocyanosis is normal-blue hands and feet