MANAGEMENT OF NEWBORN BABY

OVERVIEW

 MANAGEMENT IN DELIVERY ROOM &

DURING 1 HOUR AFTER BIRTH
 EARLY INITIATION OF BREASTFEEDING
 PERINATAL ASPHYXIA & NEONATAL
RESUSCITATION
MANAGEMENT IN DELIVERY ROOM &
DURING 1 HOUR AFTER BIRTH

 INTRODUCTION
The first hour after birth has a major
influence on the survival, future health and
well being of newly born infant. The care
they received during this period is critical to
prevent complications and ensuring intact
survival.
 THE BASIC NEEDS OF THE BABY :

1. Warmth
2. Normal breathing
3. Mother’s milk
4. Protection from infection

A baby’s survival is totally dependent upon

her mother or caregivers
Rapid assesment after birth

In the first few second after birth, a rapid visual

assesment of the baby should be performed to
answer the following questions:
1. IS THE BABY TERM?
2. IS THE AMNIOTIC FLUID CLEAR?
3. IS THE BABY BREATHING OR CRYING ?
4. IS THERE GOOD MUSCLE TONE?
If the answer to all of these questions is “yes” the
baby can remain with the mother for “skin to skin
contact”
 EARLY BREAST FEEDING INITIATION
If the answer to any of these questions is “no” the baby
should be managed and evaluated under a radiant
warmer

 RESCUSITATION
 PHYSIOLOGIC CHANGES AT BIRTH

 Lungs expand
with air
 Fetal lung fluid
leaves alveoli
 Pulmonary

arterioles dilate
 Pulmonary blood flow
increases

© 2000 AAP/AHA
…at birth
 Blood oxygen
levels rise
 Ductus
arteriosus
constricts
 Blood flows
through the
lungs to pick up
oxygen
© 2000 AAP/AHA
 BIRTH  Transition to extrauterine life

 At least 90% of newborn babies make the transition from

intrauterine to extrauterine life without difficulty.
 They require little to no assistance initiating spontaneous and
regular respirations and completing the transition from the
fetal to the neonatal blood-flow pattern.
 Approximately 10% of newborns  require some assistance
to begin breathing at birth.
 1 % need extensive resuscitative measures to survive
What Can Go Wrong During Transition?

Impaired alveolar expansion and

clearance of fetal lung fluid  insufficient ventilation

Sustained high PVR, caused by sustained

constriction of pulmonary arterioles

Hypoxia

 respiratory distress, poor perfusion with cyanosis or

pallor, need for supplemental oxygen.
Interruption of Normal Transition:

Apnea
Primary apnea
 Rapid attempts to breathe
 Respirations cease
 Heart rate decreases
 Blood pressure is usually maintained
 Responds quickly to stimulation

© 2000 AAP/AHA
Secondary Apnea
 Respirations Primary Secondary
apnea
cease apnea

 Heart
rate

Respirations
decreases
 Bloodpressure
Heart rate

decreases
 No response to
pressure

stimulation
Blood

© 2000 AAP/AHA
PERINATAL ASPHYXIA
Definition
 Perinatal asphyxia:
A condition caused by a lack of oxygen in
respired air resulting in impaired gas
exchange that if persist, leads to progressive
hypoxemia and hypercapnia with a
metabolic acidosis.
Signs of a Compromised Newborn

 Cyanosis
 Bradycardia
 Low blood pressure
 Depressed
respiratory effort
 Poor muscle tone

© 2000 AAP/AHA
 A baby  encounter difficulty before labor, during labor, after
birth.

 Problem encountered after birth  more likely to involve the

baby’s airway and or lungs.

 The baby may not breath sufficiently to force fluid from the
alveoli/ material such as meconium may block air from
entering the alveoli.

 As a result  the lungs may not fill with the air, preventing
oxygen from reaching the blood circulating through the lungs
(hypoxemia)
 A failure of gaseous distention of the lungs/ lack of oxygen
may result  sustained constriction of the pulmonary
arterioles, thus decreasing the blood flow to the lungs and
oxygen supply to body tissues.

 Normally  the newborn makes vigorous efforts to inhale

air into the lungs, brings oxygen to the pulmonary arterioles
and causes the arterioles to relax.
 When oxygen supply is decreased, and oxygen
deprivation continues  myocardial function and cardiac
output deteriorate, blood pressure falls and blood flow to
all organs is reduced.

 The consequence of this lack of adequate blood

perfusion and tissue oxygenation can be irreversible
brain damage, damage to other organs or death.
 If a baby does not begin breathing immediately after
being stimulated, he or she is likely in secondary apnea
and will require positive-pressure ventilation.
Continued stimulation will not help.
Neonatal response to asphyxia

Primary Secondary
apnea apnea

HEART RATE

TIME
Blood pressure

TIME

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 NEONATAL RESUSCITATION

 Neonatal resuscitation is a rapid sequence of

steps to be initiated if a baby’s breathing or
circulation is impaired
 The aim is to optimize the airway, breathing,
and circulation as quickly as possible
 INITIAL ASSESSMENT BLOCK
 At the time of birth  ask yourself 4 questions about the
newborn
A. Term gestation ?
B. Clear amniotic fluid ?
C. Breathing or crying ?
D. Good muscle tone ?

 If any answer is “NO”  you should continue to the initial

steps of resuscitation.

AAP 2006, Neonatal Rescucitation Program

 RESUSCITATION

Initial Steps in Resuscitation A

Positive Pressure ventilation B

Chest Compressions C

Endotracheal Intubation

Medications D

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 Birth
Routine Care
•Term gestation? Yes •Provide warmth
•Clear amniotic fluid?
•Clear airway
•Breathing or crying?
•Dry
•Good muscle tone?
•Assess color

No
30 sec •Provide warmth
•Position ; clear airway*
(as necessary)
•Dry, stimulate ,
Approximate Time

reposition

•Evaluate respirations, Breathing

Observational Care
heart rate, and color HR>100 & Pink
Cyanotic
Apneic or •Give Pink
HR<100 supplemental
30 sec oxygen
Persistently cyanotic
•Provide positive- Effective ventilation
pressure ventilation*
Post-resuscitation Care
HR>100 & Pink
HR<60 HR>60
•Provide positive-pressure ventilation*
•Administer chest compressions*
30 sec
HR<60 HR>60
•Administer AAP 2006, Neonatal Rescucitation Program
epinephrine*
evaluation Decision

action
evaluation : 4 question
Action :

INITIAL STEPS
 PROVIDE WARMTH
The baby should be placed under a radiant warmer so the
resuscitation team has easy access to the baby and the
radiant heat helps reduce heat loss

Remove
Dried with
wet linen
a warm
Under
towel
radiant
Preventing
heat warmer
loss

27
 EXTENTION

HYPEREXTENTION FLEXION

28
 DRY

Dry thoroughly

Remove wet linen

Reposition of the head

29
30
Oxygen Mask Oxygen by tubing held
in cupped hand

Free-flow Oxygen

31
 POSITIVE
PRESSURE
VENTILATION
40-60 x/minute

33
 CHEST
COMPRESSION
DRUG
 APGAR SCORE
 Is an objective method of quantifing the
newborn’s condition and useful for :
 Conveying information about the newborn’s

overall status

 Response to resuscitation
 APGAR SCORE
SIGN 0 1 2
1. Color Blue or Pale Acrocyanotic Completely
Pink

2. Heart Rate Absent < 100/min > 100/min

3. Reflex irritability No response Grimace Cry / active
withdrawal
4. Muscle Tone Limp Some Flexion Active Motion

5. Respiration Absent Weak cry; Good, crying

Hypoventilation

 Total Score : 0-10

APGAR Scoring
 AS should be assigned at 1 minute and 5 minutes after birth.

 However the resuscitation must be initiated before the 1

minute score is assigned.

 Therefore AS is not used :

 To determine the need for resuscitation

 What resuscitation steps are necessary

 Or when to use them

 When the 5 minute AS < 7, additional score should be

assigned every 5 minutes for up to 20 minutes