PREVENTION AND RESUSCITATION -DR T.

ANU SUGA

Perinatal assesment - maternal problems

Hypertension, Hypotension ,Infection Hypoxia (pulmonary or cardiac causes) Dm , Polyhydramnios, oligohydramnios Maternal vascular disease Drugs given (cocaine, lithium,mgso4 ,reserpine ) Multiple pregnancy Rh sensitisation , Previous Iud ,Teenage Or Elderely Pregnancy Malpresentation or abnormal lie

Placental Factors abruptio, placenta previa Uterine Rupture Umbilical Cord Abnormalities tight cord , Meconium stained liquor Prom >12 hrs Prolonged labour > 24 hrs Prolonged second stage > 2 hrs Fetal Factors (Anemia , Infection , Hydrops,cardiomyopathy.Cardiac Problems Neonatal Factorscyanotic heart disease , persistent primary pulmonary hypertension )

Regular Health Checkups Blood pressure Maternal Weight Gain Monitoring Abdominal Girth Measurment Serial Ultrasonogram 1. Ponderal Index Fetal Weight / Cube Fetal Length 2.Amniotic Fluid Volume 3.Absent Or Reduced Diastolic Flow In Umbilical Artery

Fetal movement counting NON STRESS TEST 2 or more 15 beats acceleration for 15 sec within20 minutes

CONTRACTION STRESS TEST oxytocin stimulation late deceleration fetal compromise

Fetal cardiotocography 110 to 150 baseline heart rate 5 to 25 beat variability two acceleration Serial maternal plasma estriol decrease of 30 %

Doppler ultrasound high systolic diastolic ratio

Reversed SD ratio

Lecithin sphingomyelin ratio > 2 Phosphatidyl glycerol Preterm babies increased risk Fetal fibronectin in cervico vaginal discharge Ultrasound assesment of cervical change antenatal steroids - fetal lung maturation beneficial delivery delayed for 24 hours

Exaggerated fetal movts asphyxiated fetus reduced or absent movt terminally Fetal heart rate initially tachycardia (catecholamines) bradycardia (prolonged diastole ) Visceral overactivity meconium in vertex presentation

 Incordinate

uterine action Oxytocin drip Prolonged head compression in cpd Analgesics and anaesthetics Maternal hypoxia in epidural analgesia

 Urgent

delivery Left lateral position Stop oxytocin Terbutaline for hypertonic uterus Correction of maternal hypotension with fluids Oxygen to mother 6 to 8 litres

 Early

diagnosis of fetal hypoxia and immediate delivery

High

risk pregnancy attended by trained person in resuscitation

person should be trained in basics

All

Over head radiant warmer with inbuilt suction Pencil handle laryngoscope (0 and 1) straight Endotracheal tubes 2,5, 3, 3.5,4 mm Suction catheters 6,8 ,10,12 press type rubber bulb Delees mucus trap Oxygen cylinder checked Ambubag and mask Epinephrine 1in 10000 dilution

Umbilical ties Scissors Cotton swabs Umbilical vessel catheterisation Tertiary centers cardiac monitors pulse oximeters Sterile warm sheets

Holding infant in inverted position Squeezing the stomach ,chest Slapping over buttocks

Avoid keeping head too low

Avoid resuscitation with 100 % o2

Supine position , towel roll under shoulder Mask tightly fit Rate 40 to 60 breaths 15 to 20 cm of h2o pressure to avoid pneumothorax Noticable chest rise Majority revived by bag and mask

INDICATIONS Tracheal Suctioning Ineffective Bag And Mask Chest Compressions Diaphragmatic Hernia Appropriate size tube Easy to intubate on asphyxiated baby Stopped on spontaneous ventilation

Heart rate below 60 Two finger or encircling the chest Two circle most effective Lower part of sternum above xiphoid cartilage pressed to a depth of one third 90 compressions and 30 ventilation (3:1) Thumbs and fingers not to be lifted Check heart rate if above 60 discontinue

Epineprine if heart rate below 60 despite 30s of ventilation I in 10,000 dilution 0.01 to 0.03 mg/kg through umbilical vein 0.05 to 0.1 mg/kg through et tube Higher doses decrease myocardial fn and worsen neurological status Volume expanders Crystalloid 10 ml/kg (blood loss )

 Gestational

age less than 23 week Birth weight < 400 gm Heart rate not detectable after ten minutes of resuscitation Congenital anomalies with certain death

 Child

shifted to NICU Stomach wash Inj vitamin k Hyperthermia avoided 10 percent dextrose started Two third maintenance Ph and base deficit determined Antibiotics for high risk factors