Pengurus Pusat IDAI & UKK Neonatologi IDAI

berkolaborasi dengan
American Academy of Pediatrics (AAP)

Training of The Trainers neonatal

Resuscitation
Jakarta, 9 - 11 Desember 2013

Integrated Resuscitation
Drugs and Fluid Administration
 Drugs and fluid is rarely indicated in
newborn resuscitation
 Administration of adequate
ventilation is the most important step
to increase the heart rate
 Administration of drugs and fluid
should not stop or reduce
ventilation and chest compression
Routes of Administration

 Preferable route of administration:

umbilical vein
 Alternative routes:
 Endotracheal tube
 Peripheral vein
 Intraosseous
Umbilical Vein Catheter/UVC

 UVC is the fastest intravascular route

to administer adrenaline
 Also used for fluid administration, as
vascular access until alternative
routes created, and to take sample
for blood gas analysis
Endotracheal Tube

 Use ETT for adrenaline administration and

artificial surfactant only
 Adrenalin should be given in higher doses
(50-100 microgram / kg) compared with IV
administration
 Should only used if the IV route is not
available
 Adrenaline administration via endotracheal
tube should not delay the search of
intravenous administration route for
adrenaline
 Peripheral Vein
 It is very hard to apply peripheral vein
access in newborn with shock and takes a
long time

Intraosseus Access
 Rarely applied to newborns
 Consider this route if operator has enough
experience
Umbilical Artery

 Not recommended for administration

of resuscitation drugs
 There are concerns associated with
complications if vasoactive drugs are
given via artery
Drugs Type and Dosing
Adrenaline

 Indication
 Ifventilation and chest compression fail
to increase heart rate to >60x/ min in 1
minute  IV adrenaline
 IfIV route is not available, give
adrenaline via endotracheal tube
 Ifendotracheal dose is not effective 
give IV dose as fast as possible
 Intratracheal
Intravenous Route
Route
• Dosing : 10-30 • Dosing: 50-100
microgram/kgBW microgram/kgBB
• Administer with • If the dose is not
rapid IV push, effective, give
continue with via IV
saline flush
• Can be repeated
every several
minutes if heart
rate is still
<60x/min
 Bicarbonate
Hypoxia

Lactic acid accumulation

Metabolic acidosis

Worsening of myocardium contraction and pulmonary vascular constriction

Decrease pulmonary blood flow

Prevent the lung to provide oxygen to blood stream

 Bicarbonate
 Reversing
intracardiac metabolic acidosis can
improve myocardial function and attain
spontaneous circulation
 Metabolic
acidosis can improve automatically with
adequate ventilation and circulation volume alone
 Postpone administration of bicarbonate until
significant metabolic acidosis found in blood gas
analysis despite normal CO2 level
 Administer only after adequate ventilation and
circulation is provided
Bicarbonate Dosing

 1-2 mmol/kg-1 (2-4 mL from

bicarbonate solution 4,2%) with slow
intravenous injection
Naloxone

 Indication
 Continuing respiratory depression even
after administration of PPV succeed to
restore normal heart rate and
 Historyof maternal narcotics
administration during labor
Do not give naloxone to babies born
from mother with suspicion of drug
abuse

withdrawal and convulsion

 Dosing
 0,1 mg/kgBW from 0,4 mg/mL solution
intravenous, followed by NaCl 0,9% flush
 Intramuscular route  slow onset of
action
 Long narcotics effect duration 
close observation to monitor recurring
respiratory depression and repeated
dose may be given
 Volume Expanders Fluid
 Indication
 Suspicion of blood loss. Baby seem to be
in a state of shock (pale, poor perfusion,
weak pulsation) and
 No adequate response to other
resuscitation procedure
 Isotonic crystalloid (normal saline) :
for initial administration
 Blood administration :
for babies with massive blood loss or
no response to resuscitation
procedure
 Dosing
 Initialdose : 10 mL/kgBW, bolus
intravenous route intravena (for several
minutes)
 Do not administer fluid too rapidly in
preterm babies because of rupture of
blood vessel risk
 If succeed, fluid administration can be
repeated to maintain improvement
 Emergency Umbilical Catheter

Tools and materials

• Antiseptic: Alcohol 70%, Iodium povidon, sterile

gauze
• Tools and materials container (trolley) dan sterile
slipcover
• Sterile drape
• Forceps
• Clamp
• Scalpel blade no 11
• Umbilical catheter no. 3,5; no. 5 / long no. 6
• Syringe 5ml,10ml and NaCl 0,9% (Normal Saline)
 Applying Emergency Umbilical
Catheter
1. Wash your hands with disinfectant solution
2. Observe patient’s condition and patient’s need for
therapy
3. Wear sterile gloves
4. Fill 3.5F atau 5F catheter connected with syringe and
stopcock with normal saline. Connect sterile 3-way-
stopper and syringe to 5 FG catheter and fill with
normal saline, and close the stopper to prevent air
entering the system
5. Clean the umbilicus and surrounding skin with
antiseptic solution, tie a string encircling
umbilical. This tie can be tighten if massive
hemorrhage present after umbilicus is cut
6. Cut the umbilicus 1–2 cm from the base with
sterile blade
Define umbilical vein and artery. Hold the
umbilicus with sterile clamp
7. Apply light pressure if hemorrhage present, clean,
and redo aseptic procedure
8. Hold the end part of catheter with sterile clamp
and insert the catheter to the vein (catheter must
inserted easily) as long as 4–6 cm. The vein will
lead upward, to the heart. Aspirate the blood
until it flow easily when you open the stopcock
toward the syringe and aspirate slowly
9. Make sure the catheter is not bent and the blood
flow easily. If bending present, pull out the
umbilicus, pull catheter backward, and reinsert.
10. Make sure there is no air buble inside the infusion
catheter and close of the set
11. Administer drugs and physiological fluids
12. If heart rate improvement achieved, remove the
catheter
13. Redo aseptic procedure in umbilical catheter area
Thank You