NEONATAL RESUSCITATION

MUSIC

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Neonatal resuscitation This film will show you how to resuscitate a newborn baby. It is based on the Resuscitation Council UK’s Guidelines and will focus on the following essential manoeuvres.

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Keeping the baby warm

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Assessing the baby

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Opening the air way

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Breathing and chest compression

Once learned these skills will allow you to help save the lives of newborn babies.

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So why do some babies need resuscitation? If a foetus experiences a significant lack of oxygen before or during delivery its breathing movements become deeper and more rapid. The heart rate at this point remains normal. But if oxygen levels continue to fall all breathing movements stop. This is called primary apnoea and at this point the heart rate will also fall.

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If the oxygen levels fall further the foetus begins to make deep, slow gasping movements. When the gasping stops the foetus then enters terminal apnoea.

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The heart rate will continue to drop and if not delivered soon the foetus will eventually die. If the foetus is delivered during primary or terminal apnoea

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NEONATAL RESUSCITATION the person attending the birth will need to help the baby breathe and in some cases establish a normal heart rate.

This is called neonatal resuscitation. 0:02:01.

Preparation The need for resuscitation is often unexpected, therefore the person attending the birth should be trained in neonatal resuscitation and well prepared at every delivery.

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Firstly, it is important to find out if the mother has experienced any conditions that may put the baby at greater risk of needing resuscitation.

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Is she expecting twins? Is the baby pre term or small?

Ask the mother if she has had any infections during the pregnancy.

If she has been in labour for over ten hours And if she has had any bleeding or evidence of meconium.

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Preparing the room is also essential. The room must be warm and free from draughts. This is to prevent the baby from getting cold. If you have a radiant warmer, switch it on.

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Make sure there is a good light source to assess the baby. This could be daylight, an overhead light or a bright torch.

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Prepare a flat, firm surface with warm, clean towels.

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Equipment

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NEONATAL RESUSCITATION A clean bag and mask is essential. A stethoscope and reliable clock are also necessary, as you will need to time the delivery and duration of resuscitation.

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Lastly, wash hands and put on gloves.

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Resuscitation We will start by showing a demonstration.

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Immediately after delivery dry the baby. Discard the wet towel. And wrap the baby in a dry, warm towel.

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Assess the baby’s colour, tone, breathing and heart rate.

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Begin resuscitation if necessary.

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Put the baby’s head in the neutral position.

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Listen to the heart rate, which should increase and look to see if the baby’s chest is moving.

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If not, give five inflation breaths. Look to see if the baby’s chest moves.

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One – two - three. Two – two - three. Three – two - three. Four – two - three. Five – two - three.

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NEONATAL RESUSCITATION

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Reassess the baby’s heart rate and consider whether the baby’s chest moved with inflation breaths.

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If there is no improvement, do a single person jaw thrust and give five inflation breaths. Look to see if the chest moves.

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One – two - three. Two – two - three. Three – two - three. Four – two - three. Five – two - three.

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Re-asses the baby’s heart rate and consider whether the baby’s chest moved with inflation breaths.

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You may also do a two person jaw thrust and give five inflation breaths.

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Look to see if the baby’s chest moves.

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One- two - three. Two – two - three. Three – two - three Four – two - three. Five – two - three.

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Reassess the baby’s heart rate and consider whether the

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NEONATAL RESUSCITATION baby’s chest moved with inflation breaths.

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Once the chest is moving, the baby may still need help to establish regular breathing.

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Give ventilation breaths.

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One- two – three – four – five – six – seven – eight – nine – ten – eleven – twelve – thirteen – fourteen - fifteen.

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If the chest is moving but the heart rate remains low give chest compressions.

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One - one – two - three. Two - one – two - three. Three – one – two - three. Four – one – two - three. Five – one – two - three. Six – one – two - three. Seven – one – two three. Eight – one – two - three. Nine – one – two - three. Ten – one - two three. Eleven – one – two - three. Twelve – one – two - three. Thirteen – one – two - three. Fourteen – one – two - three. Fifteen – one – two - three.

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Re-assess the baby.

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When the baby has established regular breathing and a normal heart rate the baby can be given to mum.

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Please note that should a small or pre-term baby require

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NEONATAL RESUSCITATION resuscitation the process is exactly the same as that for term babies. 0:08:02.9

We will now go through each stage of neonatal resuscitation.

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Keeping the Baby Warm Babies are born wet and as a result can become cold very quickly. This can lead to complications including death. Therefore it is essential to dry the baby, discard the wet towels and then wrap the baby in clean, dry, warm towels. Small and pre term babies lose heat more rapidly than bigger term babies. So it is extremely important to keep them warm.

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Assessing the Baby When a baby is delivered an assessment is made of the baby’s colour, tone, breathing and heart rate.

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A healthy baby will have good colour, meaning pink lips and tongue.

A good tone meaning good movement of its arms and legs.

Will establish regular breathing within thirty seconds and will have a heart rate above one hundred beats per minute.

This baby does not need resuscitation and can be given to mum.

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A baby in need of resuscitation will have blue or pale lips and tongue. Will be floppy with very little tone.

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NEONATAL RESUSCITATION Will not be breathing and will have a very slow heart rate of less than one hundred beats per minute.

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Where possible, get any other adult available to help and begin resuscitation immediately. You may also need to call for further help.

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Opening the Airway and Breathing The neutral position

To open the airway the baby’s head must be placed in the neutral position.

The baby should be lying on a flat surface on its back.

The neck must not be flexed or extended, meaning that the baby’s face is positioned parallel to the surface.

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Maintain the neutral position by supporting the baby’s head with your hands.

Place the mask over the baby’s mouth and nose.

The mask must be the right size and form a good seal. It should not press on the baby’s eyes or over hang the chin.

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Give five inflation breaths by slowly squeezing the bag.

Each breath should be two to three seconds long and you

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NEONATAL RESUSCITATION should see the baby’s chest moving. Allow the bag to reinflate after each breath.

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One – two - three Two – two – three Three – two – three Four – two – three Five – two – three

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After the inflation breaths reassess the baby.

Listen to the heart rate, which should increase and look to see if the baby has started to breathe.

Once the baby’s lungs have been inflated the heart rate should increase to over one hundred beats per minute and the baby should establish regular breathing.

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In most cases putting the baby’s head in the neutral position and giving five inflation breaths is all that is needed to open the airway and inflate the lungs.

The baby will establish regular breathing without further help. 0:11:56.1

If the heart rate does not increase and the chest does not move with inflation breaths then you have to open the airway using either a single person or two person jaw thrust and repeat the inflation breaths.

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NEONATAL RESUSCITATION 0:12:12

Single Person Jaw Thrust Position your fingers over the angle of the baby’s jaw. Lift it forwards and hold it in place.

Using the other hand place the mask over the baby’s mouth and nose and give five inflation breaths.

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Two Person Jaw Thrust If another person is available you may do a two person jaw thrust.

One person supports the baby’s jaw forwards with both hands and holds the mask in place. The second person gives five inflation breaths.

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One – two - three Two – two – three Three – two – three Four – two – three Five – two – three

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After either of these methods re-assess the baby.

Listen to the heart rate – which should increase.

And look to see if the baby’s chest has moved with inflation breaths.

The baby should then establish regular breathing.

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NEONATAL RESUSCITATION 0:13:29

Ventilation Breaths Once the lungs have been inflated the baby may still need help to establish regular breathing. In this case ventilation breaths are given using the bag and mask.

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Give ventilation breaths at a rate of thirty per minute. Each breath should be one second long.

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One – two – three – four – five – six – seven – eight – nine – ten – eleven – twelve – thirteen – fourteen – fifteen.

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Reassess the baby every fifteen ventilation breaths.

Make sure the head remains in the neutral position

The heart rate remains above one hundred beats per minute

And look to see if the baby is breathing.

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Continue to give ventilation breaths until the baby establishes regular breathing.

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Meconium In most cases of meconium stained liquor, the baby will not require resuscitation. However, if there is thick meconium present and the baby is not breathing don’t delay inflation breaths.

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NEONATAL RESUSCITATION Ideally the airway should be inspected under direct vision and meconium suctioned.

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Chest Compressions Chest compressions should only be considered if the baby’s heart rate remains below sixty beats per minute.

The need for chest compressions is rare.

Before starting make sure the baby’s chest is moving in response to inflation and ventilation breaths.

There is no point in giving chest compressions if the baby’s airway is not open and the lungs are not inflated.

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Encircle the baby’s chest with both hands

The fingers should support the spine and back while the thumbs are placed on the sternum just below an imaginary line joining the nipples.

The thumbs then compress the chest by a third quickly and firmly.

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Three chest compressions are given to one breath.

One - one – two - three. Two - one – two - three. Three – one – two - three.

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NEONATAL RESUSCITATION Four – one – two - three. Five – one – two - three. Six – one – two - three. Seven – one – two - three. Eight – one – two - three. Nine – one – two - three. Ten – one - two three. Eleven – one – two - three. Twelve – one – two - three. Thirteen – one – two - three. Fourteen – one – two - three. Fifteen – one – two - three. 0:16:48.0

Chest compressions are continued until the baby’s heart rate has increased.

Usually the heart rate responds quickly.

Check for a response every thirty seconds and that the chest is inflating with each breath.

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When to stop resuscitation

This is always a difficult decision and if possible should be made by an experienced clinician.

If the heart rate is not detectable after ten minutes of full resuscitation then it is appropriate to consider stopping as the outcome is extremely poor and the baby is unlikely to survive.

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To summarise

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NEONATAL RESUSCITATION Be aware that assessing the baby happens immediately after delivery and resuscitation begins straight away if needed.

The longer the baby is without oxygen the greater the risk of brain damage. So decisions and actions must be taken rapidly. The first minute of life is crucial.

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Keep the baby warm by wrapping it in dry, warm towels.

Assess the baby’s colour, tone, breathing and heart rate.

Open the airway by putting the baby’s head in the neutral position and give five inflation breaths using the bag and mask.

If this does not work use either a single person or two-person jaw thrust to open the airway and then give five inflation breaths.

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You may also need to give ventilation breaths. In rare cases chest compressions are necessary.

Reassess the baby after each intervention listening to the heart rate and looking to see if the chest is moving.

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Remember – unless the airway is open and the lungs are inflated there is no point in giving chest compressions. Therefore it is essential in neonatal resuscitation to open the airway and ensure that the lungs are inflated. In the vast majority of cases this is all that will be needed.

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