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Paediatric series Basic principles of neonatal life support Presented by Dr Kath Cooke ST5 in PaediatricsWhat is your experience of neonatal resuscitation? understand the principles of neonatal resuscitation Aims and objective s develop a logical approach to supporting transition and neonatal resuscitation at birth Breaths PaO2 Lung inflation Ventilation 160 Heart rate 120 80 40 0 0 10 20 Birth 30 40 minutesEquipmentDelayed Cord Clamping Immediate benefits Long term benefits Preterm/LBW infants Full term infantsPreterm/LBW infants Full term infants Decreases risk of IVH, Provides adequate Increases Hb at 10 Improves Hb and HCT NEC, late onset sepsis blood volume and weeks of age at 2-4 months of age birth iron stores Decreases need for Increases Hb and HCTMay be a benefit to Improves iron status blood transfusions, neurodevelopmental up to 6 months of age surfactant, outcomes in male mechanical infants ventilationOverview Dry and cover the baby, put the hat on Assess the situation § Airway §Breathing §Circulation § (Drugs)Initial actions Dry the baby Babies are small They get cold and then cover and wet very quickly with warm dry towelsHow do you start? start the clock dry the baby assess the baby with the cord remaining intact do you need help? colour Initial assessment tone breathing heart rate Airway and breathing hold head in neutral position apply mask with jaw support give inflation breaths hold head in neutral Airway and position apply mask with jaw breathing support give inflation breaths Airway and breathing hold head in neutral position apply mask with jaw support give inflation breaths Airway and breathing hold head in neutral position apply mask with jaw support give inflation breaths – start with air (in term baby)Inflation breaths A long inflation time is needed for the first few breaths to ensure adequate inflation (aeration) of the lungs. Success depends upon the replacement of alveolar fluid with air. Important to ensure that inflation breaths ARE 2-3 seconds – it is easy to give too short a breath.Give inflation breaths and then reassess What would you hope to find? An increase in HEART RATEThe heart rate increased… give The heart and is now but the baby ventilation rate has >100/min is not breaths until increased breathing the breathing is establishedYou have NOT inflated the lungs or The heart needs help to respond How can you tell which is true? reassess Once the chest is movingChest compressions you want to move oxygenated blood from the lungs to the coronary arteries it’s not that far and won’t take long use 100% oxygenChest compressions 3:1Chest compressions - landmarksConsider Drugs adrenaline glucose bicarbonate (volume - rarely)What next? reassessment temperature blood sugar parents records team debriefBabies that do not respond No heart rate at birth and still absent at 10 min The team should consider effectiveness of ongoing resuscitation, reversible factors, the overall clinical picture Stopping resuscitation should be considered and discussed if there has been no response after 20 minutes and exclusion of reversible problemsCase 1 Allow delayed cord clamping blue breathing good tone regularly fast heart rate pinkCase 2 Allow delayed cord clamping moderate breathing slow heart blue tone irregularly rateCase 3 Clamp and cut the cord unless cord intact resuscitation available blue or not slow or very pale floppy breathing slow heart rateAny questions?Summary dry and cover the babyThank you!