Resuscitation

CHAPTER 2 Resuscitation



David Cartwright, Garry Inglis, Mark Davies



Assessment


Many physiological changes occur when a fetus becomes hypoxic and/or ischaemic in utero.


After delivery, varying degrees of cardiorespiratory depression may be observed. An attempt to quantify this, made by Dr Virginia Apgar, is now called the Apgar score— a score of 0 to 2 is assigned to each of 5 variables. This score in itself does not help you in making resuscitation



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decisions, nor does it predict outcome with any degree of accuracy, but the components of it are useful in your assessment of the baby.



Heart rate (HR)


Heart rate is helpful in three situations:


1. Is it present in the totally apnoeic atonic baby?

Persisting apnoea and hypotonia despite adequate HR may be due to brain injury, a congenital neuromuscular disorder, or sedation secondary to maternal medication.


2. Is it persistently low in the pink and vigorous baby?

Whilst persistent bradycardia is almost always indicative of continuing hypoxia — check that you are delivering oxygen effectively, that your endotracheal tube (ETT) is correctly positioned, and that the chest is moving adequately — very uncommonly it is due to heart block.


3. As a useful guide to successful resuscitation — it rises rapidly.


Other considerations



• Special consideration in resuscitation must be given to babies born through meconium-stained liquor (page 10), diaphragmatic hernia, upper airway obstruction and pulmonary hypoplasia.

• Remember that an unexpected need for resuscitation (the unexpectedly ‘flat’ baby) can be a sign of infection. This is often overlooked in assessing a baby’s infection risk (see page 107).

• Hypo- or hyperthermia is common following resuscitation. Both are potentially harmful and should be avoided.

• In a prolonged resuscitation it is usually desirable to obtain vascular access. The simplest and fastest way to achieve this is to insert a catheter into the umbilical vein (UV) — see page 19 for description. This can then be used for administration of drugs (including fluids), and for obtaining blood samples.


Drugs


Drugs used in neonatal resuscitation are few:


• Oxygen — given via mask or ETT.

Whether air, 100% oxygen or some lower concentration of oxygen is used at the start of resuscitation is controversial — the policy will differ from unit to unit. Regardless, adequate inflation of the lungs is the most essential aim of resuscitation.


• Adrenaline — via UV (can also be given via IV/ETT).

• Fluid for volume expansion — via IV/UV (see note below).

• Sodium bicarbonate — via IV/UV (see note below).

• Naloxone — via IV/UV/IM (see note below).

Note: Evidence for the roles of fluid for volume expansion, bicarbonate and naloxone in resuscitation is weak. They should rarely be required.

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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on Resuscitation

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