• Key things to
  do during first 5 minutes of neonatal resuscitation

• Updated NRP
  guidelines 2015
  http://circ.ahajournals.org/content/132/18_suppl_2/S543.long

• For babies
  born precipitously in ED, always ask: 1) Term? 2) Good tone? 3)
  Breathing or crying?

  • If yes to
    all 3Qs, consider delaying cord clamping and hand baby to mother
    for skin-to-skin contact while keeping baby warm and dry.

    • Clamping of
      cord should be delayed 30-60 sec unless child requires immediate
      resuscitation

    • Associated
      with less IVH, NEC, better BPs and blood volume, but a/w more
      phototherapy requirement

  • If no to any
    of Qs, cut cord and begin resuscitation by:

    • Taking baby
      to warmer (make sure it’s on!, plastic bag from neck
      down) goal temp 36.5-37.5

    • Bulb
      syringe suction to clear secretions,

    • Dry,
      stimulate. Ventilate/oxygenate as needed.

    • Note time,
      document APGAR.

• Cutaneous
  temp monitor on liver – largest organ provides most consistent
  measurement. Hypothermia increases risk of intraventricular
  hemorrhage, respiratory issues, hypoglycemia, and late onset sepsis.

• Meconium
  aspiration no longer empirically intubated, treat similar to other
  babies with stimulation, suctioning, PPV as needed. Immediate
  intubation thought to delay resuscitation

Resuscitating a neonate: HR, RR, Pox

• HR:
  Detecting HR difficult, 3 lead ECG best, umbilical cord stethoscope
  alternate but not as accurate

  • If
    bradycardic HR <60, start chest compressions, thumb encircling
    chest wall, 3:1.

• • If not
    already done, intubate baby

  • Epi 1:10,000
    concentration, dose 0.01 mg to 0.03 mg/kg IV, or 0.05 to 0.1 mg/kg
    via ETT

• RR/Pulse
  ox – low oxygen sat is normal in first few minutes of life.
  Increases by 5% every minute of life. Place monitor on R palm/wrist
  for pre-ductal measurement, reflects blood that is going to the
  brain.

  • Normal
    preductal (right hand) O2 Sat

  • Resuscitation
    with room air (FiO2 21%) initially

  • Give
    supplemental O2 – increase FiO2 if not achieving normal saturation
    or has a HR<100.

  • PPV using
    BVM to RR 40-60 for 30 sec, CPAP

  • If need for
    CPR, then intubated baby

• Intubation:
  

ETT = [age/4+4]	Laryngoscope blade
<28 wks 2.5	Pre-term 0
28-34 wks 3.0	Term 1
34-38 wks 3.5
>38 wks 3.5 to 4	PEEP 5
Depth 3xETT size to lip

• Umbilical
  vein catheter: (PED Rm 4 has BOA cart w/ UVC kit)

  • http://emedicine.medscape.com/article/940865-overview

  • http://www.fprmed.com/Pages/Procedures/UmbilicalVein_Cath.html

  • Smiley face:
    2 eyes = umbilical arteries, flat mouth = vein. Insert catheter
    into vein 2-4cm until blood flow achieved

  • DIY UVC kit
    – 5 Fr feeding tube, 11 blade scalpel, hemostats, forceps, 3 way
    stop cock, 10ml flush, umbilical tie