HealthMedicine

Neonatal resuscitation: indications, types, stages, medicines

According to statistics, every tenth newborn child is provided with medical assistance in the delivery room, and 1% of all those born need a full range of resuscitation. The high level of training of medical personnel allows to increase the chances for life and reduce the possible development of complications. Adequate and timely resuscitation of newborns is the first step towards reducing the number of deaths and the development of diseases.

Basic concepts

What is neonatal resuscitation? This is a series of activities that are aimed at revitalizing the child's body and restoring the work of lost functions. It includes:

  • Cardiopulmonary resuscitation;
  • Intensive care;
  • Use of artificial ventilation;
  • The installation of an electrocardiostimulator, etc.

Preterm infants do not require resuscitation. They are born active, loudly screaming, the pulse and heart rate are within normal limits, the skin has a pink color, the child responds well to external stimuli. Such children are immediately put on the mother's stomach and covered with a dry warm diaper. From the respiratory tract aspirate mucous contents to restore their patency.

Conduction of cardiopulmonary resuscitation is considered an emergency assistance. It is performed in case of stopping breathing and working the heart. After such intervention, in the case of a favorable outcome, the basics of intensive care are applied. Such treatment is aimed at eliminating possible complications of stopping the work of important organs.

If the patient can not independently maintain homeostasis, the resuscitation of the newborn includes artificial lung ventilation (IVL) or pacemaker placement.

What do you need to carry out intensive care in the delivery room?

If the need for such activities is not high, then they will require one person. In the case of severe pregnancy and the expectation of carrying out a full range of resuscitation in the maternity ward, there are two specialists.

Resuscitation of the newborn in the delivery room requires careful preparation. Before the birth process, you should check that you have everything you need and make sure that the equipment is working.

  1. It is necessary to connect the heat source, so that the reanimation table and diapers are warmed up, wrap one diaper in the form of a roller.
  2. Check that the oxygen supply system is properly installed. There must be enough oxygen, properly adjusted pressure and flow rate.
  3. It is necessary to check the availability of equipment, which is required for aspiration of airway contents.
  4. Prepare tools to eliminate gastric contents in case of aspiration (probe, syringe, scissors, fixative material), meconium aspirator.
  5. Prepare and check the integrity of the resuscitation bag and mask, as well as the intubation kit.

The set for intubation consists of endotracheal tubes with conductors, a laryngoscope with different blades and spare batteries, scissors and gloves.

What is the success of the events?

Resuscitation of newborns in the delivery room is based on the following principles of success:

  • Availability of a resuscitation team - all resuscitators should be attended by resuscitators;
  • Coordinated work - the team must work together, complementing each other as one big mechanism;
  • Qualified staff - every resuscitator must have a high level of knowledge and practical skills;
  • Work taking into account the reaction of the patient - resuscitation should begin immediately if they are necessary, further measures are taken depending on the reaction of the patient's body;
  • Serviceability of equipment - equipment for resuscitation should be serviceable and accessible at any time.

Reasons for the need for events

The development of asphyxia, birth trauma, the development of congenital pathology, toxicosis of infectious genesis and other cases of unexplained etiology are among the etiological factors of oppression of the heart, lungs and other vital organs of a newborn.

Children's resuscitation of newborns and its need can be predicted even during the period of gestation. In such cases, the team of resuscitators should be ready to immediately help the baby.

The need for such events can appear under the following conditions:

  • Many or little water;
  • Repetition;
  • Diabetes of the mother;
  • hypertonic disease;
  • infectious diseases;
  • Fetal hypotrophy.

There are also a number of factors that already occur during the period of childbirth. If they appear, you can expect the need for resuscitation. Such factors include bradycardia in a child, cesarean section, premature and rapid delivery, presentation or detachment of the placenta, hypertension of the uterus.

Asphyxia of newborns

The development of violation of respiration processes with hypoxia of the organism causes the appearance of disorders on the part of the circulatory system, metabolic processes and microcirculation. Then there is a disorder of the kidneys, heart, adrenals, brain.

Asphyxia requires immediate intervention to reduce the possibility of complications. Causes of respiratory distress:

  • Hypoxia;
  • Violation of airway patency (aspiration with blood, mucus, meconium);
  • Organic brain damage and CNS;
  • Developmental defects;
  • Insufficient amount of surfactant.

Diagnosis of the need for resuscitation is carried out after assessing the state of the child on the Apgar scale.

What is being assessed 0 points 1 point 2 points
Condition of breathing Absent Pathological, non-rhythmical Loud scream, rhythmic
Heart Rate Absent Less than 100 beats per minute More than 100 beats per minute
Skin color Cyanosis Pink skin, cyanotic limbs Pink
Condition of muscle tone Absent The limbs are slightly bent, the tone is weak Active movement, good tone
Response to irritation factors Absent Slightly expressed Well-defined

Assessment of the condition to 3 points indicates the development of severe asphyxia, from 4 to 6 - asphyxia of moderate severity. Resuscitation of a newborn in asphyxia is carried out immediately after assessing his general condition.

Sequence of the state assessment

  1. The child is placed under a heat source, his skin is dried with a warm diaper. The contents are extracted from the nasal cavity and mouth. Tactile stimulation is performed.
  2. The breath is evaluated. In the case of a normal rhythm and the presence of a loud scream, go to the next stage. With non-rhythmical breathing, the ventilation is carried out with oxygen for 15-20 minutes.
  3. The heart rate is assessed. If the pulse is higher than 100 beats per minute, the next stage of the examination is passed. In the case of a heart rate of less than 100 strokes, ventilators are performed. Then, the effectiveness of the measures is evaluated.
    • Pulse below 60 - indirect cardiac massage + mechanical ventilation.
    • Pulse from 60 to 100 - IVL.
    • Pulse above 100 - IVL in case of irregular breathing.
    • After 30 seconds, with ineffectiveness of indirect massage with mechanical ventilation, it is necessary to conduct drug therapy.
  4. The skin color is inspected. Pink color indicates the normal state of the child. With cyanosis or acrocyanosis, it is necessary to give oxygen and observe the condition of the baby.

How is primary resuscitation carried out?

Be sure to wash and treat your hands with an antiseptic, put on sterile gloves. The child's birth time is fixed, after taking the necessary measures - is documented. The newborn is placed under a heat source, wrapped with a dry warm diaper.

To restore airway patency, you can lower the head end and put the child on the left side. This will stop the aspiration process and will remove the contents of the mouth and nose. Gently suction the contents without resorting to a deep introduction of the aspirator.

If such measures do not help, resuscitation of the newborn continues through the rehabilitation of the trachea with the help of a laryngoscope. After the appearance of breathing, but the absence of its rhythm, the child is transferred to the ventilator.

The Neonatal Resuscitation and Intensive Care Unit accepts the child after primary resuscitation to provide further care and support for life functions.

Ventilation of the lungs

Stages of resuscitation of newborns include artificial ventilation. Indications for ventilation:

  • Lack of breathing or the appearance of convulsive respiratory movements;
  • Pulse less than 100 times per minute, regardless of the state of breathing;
  • Resistant cyanosis in the normal operation of the respiratory and cardiovascular systems.

This complex of activities is carried out with the help of a mask or bag. The head of the newborn is slightly thrown back and a mask is applied to the face. It is held by index fingers and thumbs. Others withdraw the jaws of the child.

The mask should be on the area of the chin, nose and mouth. It is enough to ventilate the lungs at a frequency of 30 to 50 times per minute. Ventilation with a bag can cause air to enter the stomach cavity. You can remove it from there with the help of a gastric tube.

To control the effectiveness of the exercise, you need to pay attention to the rise of the chest and changes in heart rate. The child continues to monitor until the rhythm of breathing and cardiac contractions are fully restored.

For what and how is intubation performed?

Primary reanimation of newborns also includes intubation of the trachea, in the case of ineffective ventilation for 1 minute. The right choice of tube for intubation is one of the important points. It is done depending on the weight of the child and his gestational age.

Intubation is also performed in the following cases:

  • The need to remove meconium aspiration from the trachea;
  • Prolonged ventilation;
  • Facilitating the manageability of resuscitation measures;
  • Adrenaline administration;
  • Deep prematurity.

On the laryngoscope, turn on the light and take it to the left arm. With your right hand, hold the head of the newborn. The blade is inserted into the mouth and held to the base of the tongue. Raising the blade towards the handle of the laryngoscope, the resuscitator sees a vocal cavity. The tube for intubation is injected from the right side into the oral cavity and is passed through the vocal cords at the moment of their opening. This happens on inspiration. The handset is held before the scheduled mark.

Remove the laryngoscope, then - the conductor. The correctness of the introduction of the tube is checked by squeezing the respiratory bag. The air enters the lungs and causes a chest excursion. Then the oxygen supply system is connected.

Indirect heart massage

Resuscitation of a newborn in the delivery room includes an indirect heart massage, which is indicated at a heart rate of less than 80 beats per minute.

There are two ways to conduct an indirect massage. When using the first, pressing on the chest is done using the index and middle finger of one hand. In another version, the massage is performed with the thumbs of both hands, and the remaining fingers participate in supporting the back. The resuscitator-neonatologist conducts pressure on the border of the middle and lower third of the sternum, so that the thorax cuffs by 1.5 cm. The frequency of pressing is 90 per minute.

It is necessary to watch, so that inhaling and pressing on the chest are not carried out simultaneously. In a pause between pressure, you can not remove your hands from the surface of the sternum. Pressing on the bag is done after every three pressings. For every 2 seconds you need 3 pressure and 1 ventilation.

Actions when the water is polluted with meconium

Features of neonatal resuscitation include assistance in staining amniotic fluid with meconium and evaluating a child on the Apgar scale less than 6 points.

  1. In the process of delivery after the appearance of the head from the birth canal immediately aspirate the contents of the nasal cavity and mouth.
  2. After the birth and placement of the baby under the heat source, it is advisable to hold the intubation with the largest possible tube to extract the contents of the bronchi and trachea.
  3. If it is possible to extract the contents and it has an admixture of meconium, then it is necessary to re-intubate the newborn with another tube.
  4. Ventilation is established only after all the contents have been extracted.

Drug therapy

Children's resuscitation of newborns is based not only on conducting manual or hardware interventions, but also on the use of medications. In the case of ventilation and indirect massage, when the measures are ineffective for more than 30 seconds, drugs are used.

Resuscitation of newborns involves the use of adrenaline, a means to restore the volume of circulating blood, sodium hydrogencarbonate, naloxone, dopamine.

Adrenaline is injected through the endotracheal tube into the trachea or into the vein struino. The concentration of the drug is 1:10 000. The drug is used to increase the strength of heart contraction and acceleration of heart rate. After endotracheal administration, continue IVL, so that the drug can be evenly distributed. If necessary, the agent is administered after 5 minutes.

Calculation of the dose depending on the weight of the child:

  • 1 kg - 0.1-0.3 ml;
  • 2 kg - 0.2-0.6 ml;
  • 3 kg - 0.3-0.9 ml;
  • 4 kg - 0.4-1.2 ml.

When blood loss or the need to replenish the volume of circulating blood, albumin, physiological sodium chloride solution or Ringer's solution is used. The drugs are injected into the vein of the umbilical cord struino (10 ml per 1 kg of body weight of the baby) slowly for 10 minutes. The introduction of fillers BCC allows you to raise blood pressure, reduce the level of acidosis, normalize the pulse rate and improve tissue metabolism.

Resuscitation of newborns, accompanied by effective ventilation, requires the introduction of sodium hydrogencarbonate in the umbilical vein to reduce signs of acidosis. The drug should not be used until adequate ventilation of the child's lungs is established.

Dopamine is used to increase the cardiac index and glomerular filtration. The drug dilates the blood vessels of the kidneys and increases the sodium clearance with the use of infusion therapy. Intravenously injected microfluidically under constant monitoring of blood pressure and heart rate.

Intravenous naloxone is administered at the rate of 0.1 ml of the preparation per 1 kg of the child's body weight. The remedy is used in cases where skin color and pulse are normal, but there are signs of respiratory depression. The newborn should not be given naloxone when the mother uses narcotic drugs or undergoes treatment with narcotic analgesics.

When to stop resuscitation?

The ventilation is continued until the child attains 6 Apgar points. Such an assessment is conducted every 5 minutes and lasts up to half an hour. If after this time the newborn has an indicator less than 6, then it is transferred to the Maternity Hospital, where further resuscitation is carried out, intensive therapy of newborns.

If the effectiveness of resuscitative measures is completely absent and asystole and cyanosis is observed, the activities last up to 20 minutes. At occurrence of even the slightest signs of efficiency, their duration increases for all time, while measures give a positive result.

Department of Neonatal Resuscitation

After successful restoration of the lungs and heart, the newborn is transferred to the intensive care unit. There doctors work is aimed at preventing possible complications.

Newborn after resuscitation needs to prevent the onset of cerebral edema or other disorders of the central nervous system, restoration of kidney function and excretory function of the body, normalization of blood circulation.

The child may experience metabolic disturbances in the form of acidosis, lactic acidosis, which is caused by impaired peripheral microcirculation. From the side of the brain, there may appear convulsive seizures, hemorrhage, cerebral infarction, edema, development of coma. Also, there may be violations of the function of the ventricles of the heart, acute kidney failure, atony of the bladder, insufficiency of the adrenal glands and other endocrine organs.

Depending on the condition of the baby, it is placed in a kuvez or oxygen tent. Specialists observe the work of all organs and systems. Feed allow the child only after 12 hours, in most cases - through the nasogastric tube.

Errors that are not allowed

Strictly forbidden to carry out activities, the safety of which is not proven:

  • To pour the baby with water;
  • Squeeze his chest;
  • To strike the buttocks;
  • Direct in the face an oxygen stream and the like.

An albumin solution can not be used to increase the initial BCC, as this increases the risk of a fatal outcome of a newborn.

Carrying out resuscitation does not mean that the baby will have any deviations or complications. Many parents expect pathological manifestations after the newborn was in the intensive care unit. Reviews of such cases show that in the future children have the same development as their peers.

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