Resuscitation (Neonatal): Difference between revisions
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== Principles of Resuscitation == | == Principles of Resuscitation == | ||
=== Thermal Regulation === | === Thermal Regulation === | ||
*Place newborn in neutral thermal environment even before initiate ABCs | *Place newborn in neutral thermal environment even before initiate ABCs | ||
*Gently dry newborn with warm towel | *Gently dry newborn with warm towel | ||
=== Airway === | === Airway === | ||
*Optimize | *Optimize | ||
| Line 14: | Line 14: | ||
**Indicated if pt is poorly responsive or fails BVM | **Indicated if pt is poorly responsive or fails BVM | ||
**If have time precut ET tube at 13cm mark | **If have time precut ET tube at 13cm mark | ||
**Lip placement = 6 + wt (kg) | |||
**After intubation suction trachea to prevent aspiration (if +meconium) | **After intubation suction trachea to prevent aspiration (if +meconium) | ||
{| width="200" border="1" cellpadding="1" cellspacing="1" | {| width="200" border="1" cellpadding="1" cellspacing="1" | ||
|- | |- | ||
| Tube Size | | Tube Size / age / wt | ||
| | | Blade | ||
| | | Suction Catheter | ||
|- | |- | ||
| 2.5 | | 2.5 / <28 / <1000 | ||
| Miller 0 | |||
| | | 5F or 6F | ||
|- | |- | ||
| 3.0 | | 3.0 / 28-34 / 1000-2000 | ||
| Miller 0 | |||
| | | 6F or 8F | ||
|- | |- | ||
| 3.5 | | 3.5 / 34-38 / 2000-3000 | ||
| Miller 0 | |||
| | | 8F | ||
|- | |- | ||
| 4.0 | | 3.5-4.0 />38 / >3000 | ||
| Miller 0-1 | |||
| | | 8F or 10F | ||
|} | |} | ||
===Breathing=== | |||
< | *Apneic and/or bradycardic (<100 bpm) | ||
**Attempt tactile stimulation first | |||
**If unsuccessful perform BMV at 40-60 breaths/min | |||
**After intubation use: | |||
***Inflation pressure ~ 20 | |||
< | ===Circulation=== | ||
*CPR | |||
**Begin if despite assisted ventilation x30s HR still <60 | |||
**3 compressions:1 breath (total 90 compresions:30 breaths per min) | |||
====Vascular Access=== | |||
*Umbilical vein is site of choice | |||
====Volume Expansion==== | |||
*NS 10-20mL/kg IV over 5-10min | |||
*O Rh-negative blood | |||
====Medications==== | |||
*Epinephrine | |||
**Indicated for aystole or HR < 60 despite CPR >30s | |||
**0.01-0.03mg/kg IVP q3-5min | |||
*Sodium Bicarbonate | |||
**Helps to counteract negative inotropy/pulm HTN caused by acidosis | |||
**Only give once adequate ventilation is established | |||
**1-2 mEq/kg of 4.2% solution (2-4 mL/kg) | |||
*Naloxone | |||
**Give if persistent resp depression AND maternal narcotics w/in 4hr | |||
**0.1mg/kg IV | |||
== | ==Special Problems== | ||
===Cyanosis=== | |||
== | *Must distinguish between central and peripheral | ||
*Consider prostaglandin E1 0.05-0.1 mcg/kg/min for cyanotic heart dz | |||
== | ===Pneumothorax=== | ||
*Tension PTX is highly related to subsequent ICH | |||
== | **Place 18-20ga catheter into 4th IC in ant axillarly line | ||
===Hypoglycemia=== | |||
*<30-35 in preterm newborn | |||
*<35-40 in term newborn | |||
*Treatment | |||
**D10W 2mL/kg IV | |||
===Congenital Diaphragmatic Hernia=== | |||
*Persistent respiratory distress w/ "seesaw" pattern | |||
*Treat via immediate intubation, OG tube placement | |||
**Use lowest peak insp presure that allows for adequate chest rise | |||
==Withholding Resuscitation== | |||
*Consider if: | |||
**<22wk or <400g | |||
**No signs of life after 10min of CPR | |||
== See Also == | |||
[[Pediatric Advanced Life Support (PALS)]] | [[Pediatric Advanced Life Support (PALS)]] | ||
== Source == | == Source == | ||
Tintinalli | Tintinalli | ||
[[Category:Peds]] [[Category:Airway/Resus]] | [[Category:Peds]] | ||
[[Category:Airway/Resus]] | |||
Revision as of 21:05, 8 July 2011
Principles of Resuscitation
Thermal Regulation
- Place newborn in neutral thermal environment even before initiate ABCs
- Gently dry newborn with warm towel
Airway
- Optimize
- Position head in sniffing position
- Suction nose and mouth
- Intubate
- Indicated if pt is poorly responsive or fails BVM
- If have time precut ET tube at 13cm mark
- Lip placement = 6 + wt (kg)
- After intubation suction trachea to prevent aspiration (if +meconium)
| Tube Size / age / wt | Blade | Suction Catheter |
| 2.5 / <28 / <1000 | Miller 0 | 5F or 6F |
| 3.0 / 28-34 / 1000-2000 | Miller 0 | 6F or 8F |
| 3.5 / 34-38 / 2000-3000 | Miller 0 | 8F |
| 3.5-4.0 />38 / >3000 | Miller 0-1 | 8F or 10F |
Breathing
- Apneic and/or bradycardic (<100 bpm)
- Attempt tactile stimulation first
- If unsuccessful perform BMV at 40-60 breaths/min
- After intubation use:
- Inflation pressure ~ 20
Circulation
- CPR
- Begin if despite assisted ventilation x30s HR still <60
- 3 compressions:1 breath (total 90 compresions:30 breaths per min)
=Vascular Access
- Umbilical vein is site of choice
Volume Expansion
- NS 10-20mL/kg IV over 5-10min
- O Rh-negative blood
Medications
- Epinephrine
- Indicated for aystole or HR < 60 despite CPR >30s
- 0.01-0.03mg/kg IVP q3-5min
- Sodium Bicarbonate
- Helps to counteract negative inotropy/pulm HTN caused by acidosis
- Only give once adequate ventilation is established
- 1-2 mEq/kg of 4.2% solution (2-4 mL/kg)
- Naloxone
- Give if persistent resp depression AND maternal narcotics w/in 4hr
- 0.1mg/kg IV
Special Problems
Cyanosis
- Must distinguish between central and peripheral
- Consider prostaglandin E1 0.05-0.1 mcg/kg/min for cyanotic heart dz
Pneumothorax
- Tension PTX is highly related to subsequent ICH
- Place 18-20ga catheter into 4th IC in ant axillarly line
Hypoglycemia
- <30-35 in preterm newborn
- <35-40 in term newborn
- Treatment
- D10W 2mL/kg IV
Congenital Diaphragmatic Hernia
- Persistent respiratory distress w/ "seesaw" pattern
- Treat via immediate intubation, OG tube placement
- Use lowest peak insp presure that allows for adequate chest rise
Withholding Resuscitation
- Consider if:
- <22wk or <400g
- No signs of life after 10min of CPR
See Also
Pediatric Advanced Life Support (PALS)
Source
Tintinalli