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Neonatal Resuscitation
Neonatal Resuscitation
Neonatal Resuscitation
Jess Paul
UBC RCPC-EM Residency Program
RCH Grand Rounds April 23, 2014
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NRP: Who cares?
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Who cares?
Stop, breathe
Ventilation
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NRP
Lesson 6: Medications
Systemic hypotension
Poor cardiac contractility
Bradycardia
Teamwork!
Flow:
A: Initial Steps
B: Adequate Ventilation
C: Chest Compressions
D: Epinephrine
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Lesson 2: Initial Steps of
Resuscitation
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3 Essential Questions
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CPAP/blended O2/sup O2
Sniffing position
Tackle stimulation
Vigorous:
Good tone
Strong resp efforts
HR <100
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Lesson 3: Positive Pressure
Ventilation
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OG: 8 F feeding tube
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Quiz
Effective ventilation:
Bilateral breath sounds
Chest movement
PPV:
Apnea/gasping
HR <100
Persistent cyanosis and low O2 if supp O2 at 100%
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Lesson 4: Chest Compressions
100% O2
Rate:
Chest compressions 90/min
Breathes 30/min
3:1 ratio
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Quiz
Miller blade
00 extreme preterm
0 preterm
1 term
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LMA
Size 1
Contraindicated in:
Meconium
Preterm infants (<32 wks) or <2000g
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Quiz
Blade by GA
Depth: wt in kg +6
No LMA
<32 wks
mec
Indications:
Non-vigorous mec suctioning
If BMV not effective or prolonged
During chest compressions
Special circumstances:
Extreme prematurity
Surfactant administration
Diaphragmatic hernia
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Lesson 6: Medications
IO?
Epi 1:10,000
1m1/kg by ET (max 3ml dose)
0.1m1/kg by IV Q3-5min
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Umbilical Vein Catheter Steps
Depth 2-4cm
Withdrawal blood
Emergent UVC
http://www.nejm.org.ezproxy.library.ubc.ca/doi/full/10.1056/NE
JMvcm0800666
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Fluid Replacement
NS/Ringers/Whole blood
Fluid
Fetal/maternal hemorrhage or shock despite resuscitation
NS/Ringers/whole blood
10ml/kg IV over 5-10 mins
Epi 1:10,000
1m1/kg by ET x 1(max 3ml dose)
0.1m1/kg by IV Q
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Lesson 7: Special Considerations
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Choanal Atresia
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Pierre Robin Syndrome
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Congenital Diaphragmatic Hernia
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Pneumothorax (transillumination)
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Pleural effusions
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Hypoglycemia
IV glucose:
<4 and symptomatic
<2.5 and asymptomatic for 0-4 hrs of age
<3.5 and asymptomatic for 4-24 hrs of age
Repeat Q10-20mins
Pulmonary hypertension
Supp O2 or PPV
Metabolic Acidosis
No bicarb unless adequate ventilation
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Therapeutic Hypothermia
Limited surfactant
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Giving PEEP
No trendelenburg
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Quiz
PEEP if intubated
Continuous monitoring
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Lesson 9: Ethics and Care at the
End of Life
Discontinuation of resuscitation:
10 mins of no HR
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Practicality
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The Very Bottom Line
Ventilation!!!
References:
AHA. Textbook of Neonatal Resuscitation. 6 edition. Elk Grove Village, Dallas,
Tex: American Academy of Pediatrics; 2011.
Anon. Addendum to the NRP Provider Textbook 6th Edition; Recommendations
for specific modifications in the Canadian context. 2011.
Lo MD, Mazor SS. Chapter 11 Neonatl Resuscitation. In: Rosen’s Emergency
Medicine-Concepts and Clinical Practice.Vol 1. 8th ed.
Anon. CPS Medications for Neonatal Rsuscitation Program 2011 Canadian
Adaptation.
Kester-Greene N, Lee JS. Preparedness of urban, general emergency
department staff for neonatal resuscitation in a Canadian setting. CJEM.
2013;15(0):1–7.
Anderson J, Leonard D, Braner DAV, Lai S, Tegtmeyer K. Umbilical Vascular
catheterization. New England Journal of Medicine. 2008.