Neonatal Resuscitation | Distressed Newborns

Care of Newborn in Distress:

Airway: as the head is delivered, suction the mouth first then the nose. Keep the head down a bit from the body to allow fluids to drain

Breathing: Rub soles of feet and back to stimulate. Newborns are sensitive to hypoxia> brain damage. Primary apnea is reversed with stimulation. Secondary apnea requires ventilation
Use a rolled towel under shoulders. Sniffing position, don’t hyperextend the trachea
If breathing is absent or irregular, BVM at 40-60 breaths per minute

Circulation/Heart Rate: Cardiac arrest is secondary to respiratory failure. If HR is below 100 beats per minute, ventilate with 100% O2. If HR is below 60 initiate CPR

Color: If central cyanosis persists after stimulation and they are breathing, give O2. Acrocyanosis or peripheral cyanosis (blue hands and feet) can persist for up to 48 hours after birth.

If an IV is needed: arms, feet and scalp are the most common spots. Fluid therapy is 10 mL/kg of body weight over 5-10 min. Normal saline or Lactated Ringers.

Meconium: thick greenish black stools that usually pass after birth. Stress can cause it earlier. Neonate can aspirate and this is an emergency> respiratory distress. Vigorous suctioning of the hypopharanx before delivery of the shoulders.

Preterm infants:
Less Surfactant: reduces surface tensions of fluids in the lungs. Makes diffusion of O2 and CO2 more efficient. Without it, newborns are unable to keep their lungs inflated.
Less fat, translucent skin, cartilage soft, reflexes absent, can’t cough, suck, swallow or gag.
Apnea of prematurity, more prone to SIDS
Sepsis: generalized bacterial infection. 4x greater chance of developing it

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