Advanced Neonatal Procedure1
Advanced Neonatal Procedure1
Advanced Neonatal Procedure1
Purposes
To estabilish and maintain a clear airway.
To ensure effective circulation.
To correct any acidosis present.
To prevent hypothermia, hypoglycemia and haemorrhage.
Articles
Suctioning articles
Bulb syringe
De lee mucus trap with no. 10 Fr catheter or mechanical suction.
Suction catheters no. 6,8,10.
Feeding tube no. 8 Fr and 20ml syringe.
Bag and mask articles.
Infant resuscitation bag with pressure release valve or pressure gauge with reservoir, capable
of delivering 90-100% oxygen.
Face masks with cushioned rims (Newborn and premature sizes)
Oral airways ( Newborn and premature sizes)
Oxygen with flowmeter and tubing.
Intubation articles.
Laryngoscope with straight blades No. “O” ( premature), No “1” ( Newborn)
Extra bulbs and batteries for laryngoscope.
Endotracheal tubes. Sizes- 2.5, 3.0, 3.5 and 4.0 mm internal diameter.
Styllet
Scissors
Medications
Epinephrine 1:10, 000 ampoules (1ml ampoule of 1:1,000 available in India)
Nalaxone hydrochloride (Neonatal narcan 0.02mg/ml)
Volume expander
5% albulum solution.
Normal saline
Ringer’s Lactate
Sodium bicarbonate 4.2% (1mEq/2ml)
7.5% strength available in India approximately 0.9 mEq/ml)
Dextrose 10% concentration 250ml.
Sterile water 30ml
Normaline saline 30ml.
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Miscellaneous
Radiant warmer
Stethoscope.
Adhesive tape and bandages scissors.
Syring 1ml, 2ml, 5ml and 20 ml sizes.
Needles Nos 21,22 and 26 G
Umbilical Cord clamp
Warm dry towels.
TABC of Resuscitation
The components of the neonatal resuscitation procedure related to the TABC of resuscitation are
shown here:
Estabilish an open airway:- Position the infant, suction mouth, nose and in some
A instances the trachea. If necessary, insert an ET (endotracheal) tube to ensure an open airway.
Resuscitation Algorithm
As soon as baby is delivered, assess for five signs while cord is being cut.
a. Clear the meconium?
b. Breathing or crying?
c. Good muscule tone? ( Flexed posture and active movement of baby denotes good tone).
d. Colour pink? (Look at tongue and lips).
e. Term gestation?
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If answers to all the five questions are ‘Yes’ then baby does not require any active resuscitation
and routine care should be provided. The baby can be placed on mother’s abdomen after drying
and cleaning. If required, secretions can be wiped off using a clean cloth. Providing skin- to- skin
contact and allowing breastfeeding will help in easy transition to extra uterine life.
30 Sec
No
Provide Warmth
Position, clear airway* (as
necessary)
Dry, stimulate, reposition
Give oxygen (as necessary)
Evaluate respirations,
heart rate and color Breathing Supportive care
HR < 60 HR > 60
30 Sec
Provide positive pressure ventilation*
Administer chest Compressions
HR < 60
* Endotracheal intubation may
Administer be considered at several steps.
epinephrine*
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RESUSCITATION ALGORITHM
Procedure
Procedure
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If heart is above 100bpm and spontaneous respirations are present, discontinue bagging.
If heart rate is 60-100bpm and increasing, continue ventilation, check whether chest is
moving adequately.
If heart rate is below 80bpm, start chest compression.
If heart rate is below 60 bpm, in addition to bagging and chest compressions, consider
intubation and initiate medications.
Signs of improvement.
Increasing heart rate.
Spontaneous respirations.
Improving colour
Continue to provide free flow oxygen by face mask after respirations are established. If the baby
deteriorates, check the following:-
Chest Compressions
Chest compressions consist of rhythmic compressions of the sternum that compresses the heart
against the spine, increase the intrathoracic pressure and circulates blood to the vital organs.
Chest compressions must always be accompanied by ventilation with 100% oxygen to assure
that the circulating blood is well oxygenated.
Indications
Heart rate less than 60bpm after bagging with 100% oxygen for 15-30 seconds.
Heart rate 60-80bpm and not increasing after bagging with 100% oxygen for 15-30 seconds.
Procedure
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contact with the chest between compressions. injury.
3. Use three compressions followed by one ventilation for a Simultaneous compression
combined rate of compressions and ventilation for a combined and ventilation may
rate of compressions and ventilations of 120 each minute. Pause interfere with adequate
for ½ second after every third compression for ventilation. ventilation. The short
pause allows air to enter
the lungs.
4. Check the heart rate after 30 seconds. If it is 60 bpm or more, Periodic evaluation is
discontinue compressions but continue ventilation until the heart necessary to ensure that
rate is more than 100bpm and spontaneous breathing begins. treatment is appropriate to
the infant’s status.
Note: If cardiac compression fails, endotracheal intubation should be initiated.
Endotracheal Intubation
Indications
Heart rate below 60 per minute inspite of begging and chest compressions. Presence of
meconium in the amniotic fluid.
Procedure
Medications
Medications should be administered if despite adequate ventilation with 100% oxygen and chest
compressions the heart rate remains at 80 bpm.
Recording
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Record the procedure in nurses’ record. Document the baby’s condition before and after
procedure.
Caring for a baby being exposed to light source for prescribed of time.
Purpose
Fluorescent lamps or “bililights” placed over the infant who is usually in an incubator or
under a radiant warmer.
Halogen lamps.
Fiberoptic phototherapy blankets or pads.
Procedure
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from the infant will not be effective.
7. Place the baby naked under light in the isolette. Exposes the skin as much as possible for
maximum exposure to light.
8. Cover the baby’s eyes with eyepads. Protects eyes from the effect of high
intensity lights on retina and avoids
abrasions to cornea.
9. Cover the genitals of male babies with the napkin. Protects testicles from the high intensity
lights.
10. a. If fiberoptic pad is used, place it under the baby Maintains the position.
in contact with the baby’s skin.
b. Keep the baby on his side with a rolled baby
sheet on the side.
11. Switch on bili lights and/or machine for the
fiberoptic pad.
12. Change position every 2 hours. Ensures that light reaches all areas of the
body.
13. Record in baby’s chart, all details about starting Acts as a communication between staff
the procedure, observations made and precautions members.
taken.
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Loose green stool resulting from increased bile flow and peristalisis. Stool may damage the
skin and cause fluid loss.
Tanning effect from the light.
Bronze baby syndrome- a grayish brown discoloration of skin and urine.
Skin rash.
Temporary lactose intolerance.
3. Care of Newborn in Incubator
Definition
Providing care to prematurely born or sick infants in a device called incubator which
keep them warm.
Purposes
Deck
Mattress which is enclosed by a clear plastic canopy.
Air intake pipe.
Microfilter assembly.
Oxygen inlet.
Thermostat.
Caliberated dial.
Arm ports.
Hood: Single walled rectangular hood. The hood has a large door to aid in placing or
removing baby from incubator. There are four elbow operated parts for better access during
small procedures, inlet for IV tubes, probes, endotracheal tubes etc. Canopy can be lifted for
cleaning and access.
Control panel: Heater, blower and electronics.
Lower unit: This consists of control box, touch sensor, front panel with display, humidifier,
airducts and filter. The following are displayed on the front of the panel.
Air temperature
Patient temperature
Control temperature
Cabinet: This provides support for hood, canopy and lower unit. It houses main switch, fuse
and power cord connector. The cabinet has three drawers for storage space.
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Humidity percentage: Air is circulated by configural blower. Fresh air enters through air
filters located at the end of incubator. Fresh air is mixed with circulating air from incubator
conopy and passed over heater and humidifier. Temperature inside incubator is maintained
by sensor placed on hood.Thus, heated air flow maintains surroundings of infant at desired
temperature.
Procedure
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4. Assisting in Exchange Transfusion
Definition
Assisting in withdrawing a baby’s blood which has high bilirubin content and replacing with
fresh blood through umbilical vein.
Aims
Non- obstructive jaundice with serum bilirubin level of 20mg/dl or more in fullterm and
15mg/dl in preterm infants, e.g. Rh or ABO incompability.
Kernicterus irrespective of serum bilirubin level.
Haemolytic disease of the newborn under following situations:-
Cord Hb 10% or less.
Cord bilirubin 5mg/dl or more.
Rise of serum bilirubin of more than 1mg/dl/hour.
Maternal antibody titer of 1:64 or more, positive direct Coombs’ test and previous history
of a severly affected baby.
Articles
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f. I.V. stand
g. Injection normal saline 500ml.
h. Injection heparin.
i. 3-way stopcock.
j. Resuscitation equipment and oxygen source.
k. Heat source.
l. Suction apparatus with mucus sucker.
m. Umbilical vein catheter.
n. NG tube no 5,6,8.
o. Sterile linen bundle with 2 sheets and 1 biopsy towel.
p. Mask and gloves.
q. Cord tie.
r. Specimen containers.
s. Specimen tubes.
t. Adhesive plaster, scissors and extra syringes.
u. Emergency drugs like:-
Injection Adrenalin.
Inj. Calcium gluconate.
Injection Soda bicarbonate.
Inj. Amniophylline
v. Blood giving set.
w. Cross splint.
Choice of Donor Blood
Procedure
Bacterial sepsis.
Thrombocytopenia.
Portol vein thrombosis.
Umbilical vein perforation
Dysrhythmia
Cardiac arrest.
Hypocalcemia
Hypoglycemia
Hypomagnesemia
Metabolic acidosis
Alkalosis
HIV, Hepatitis B infections.
Graft versus host disease.
Special considerations
If citrated or heparinized donor blood is used, one should be prepared for hypocalcemia,
hypoglycemia, hyperkalemia and metabolic acidosis. Further, citrated blood leaves the infant
with low Hb level. So as, a precaution calcium gluconate at regular intervals should be given
when using citrated blood for exchange.
For every 100ml of blood transfused one milli equivalent of sodium bicarbonate is given to
combat metabolic acidosis.
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