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Neonatal resuscitation-NNR PowerPoint Presentation

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Description : Check out this medical titled "Neonatal resuscitation (NNR)" by Dr. Renu Singh.

This medical talks about Neonatal resuscitation (NNR), the medical intervention given to a newborn baby who is not breathing or is breathing poorly at birth. It involves a series of steps aimed at helping the baby breathe on their own and maintain adequate oxygen levels in the body. NNR is a critical aspect of newborn care, as failure to initiate timely resuscitation can lead to serious complications and even death.

The steps involved in NNR depend on the severity of the babys condition, but generally include clearing the airway, providing oxygen, and providing chest compressions if necessary. The healthcare provider will also assess the babys heart rate, color, and muscle tone to determine the appropriate level of intervention.

NNR is typically performed by trained healthcare professionals, including obstetricians, midwives, and neonatal nurses. It is important that healthcare providers who attend deliveries have the necessary skills and equipment to provide NNR when needed. Regular training and review of NNR skills and protocols can help ensure that healthcare providers are prepared to respond appropriately in emergency situations.

Tags : Neonatal resuscitation, Emergency Medicine, Emergency Medicine

Published on : Apr 14, 2023 | Views : 2884 | Downloads : 2

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Neonatal resuscitation (NNR) Dr. Renu Singh
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Burden of the problem Birth asphyxia 23% of the 1 million neonatal deaths in India Long term neurological complications Death NNR (Neonatal resuscitation) :simple, inexpensive, cost effective method Problem: NNR often not initiated, incorrect use of methods
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Successful NNR: factors Anticipation: call a skilled personnel Adequate preparation Accurate evaluation, algorithm based Prompt initiation of support
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1.Anticipation: High risk delivery Maternal condition Advanced maternal age ,DM, HT, stillbirth, fetal loss, early neonatal death Fetal condition Prematurity, post maturity, congenital anomalies, multiple gestations Ante partum complications: APH, oligo /polyhydramnios Delivery complications Malpresentation, MSAF, instrumental delivery, antenatal asphyxia with abnormal FHR
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2. Adequate preparation Radiant warmer is turned on,& is heating Oxygen source is open with adequate flow through the tubing Suction apparatus tested, functioning properly Laryngoscope is functional with bright light Resuscitation bag & mask demonstrates an adequate seal & generation of pressure
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Radiant warmer
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Successful NNR: factors Anticipation: call a skilled personnel Adequate preparation Accurate evaluation, algorithm based Prompt initiation of support
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Evaluation, algorithm based Rapid assessment of neonate clinical status Is the infant full term? Is the infant breathing or crying? Does the infant has good muscle tone? Yes: no resuscitation, routine neonatal care No: needs resuscitation
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Approach to resuscitation2010 AHA, AAP A: initial steps(provide warmth, clear airway if necessary, dry, stimulate) B: breathing(ventilation) C: chest compressions (circulation) D: administration of drugs &/or volume expansion
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Resuscitation: initial steps Provide warmth Head position “ sniffing position” Clearing the airway, if necessary Drying the baby Tactile stimulation for breathing
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AAP Algorithm
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AAP Algorithm
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PPV: Positive pressure ventilation Form of assisted ventilation Needed when there is no improvement in HR Also assess chest wall movements Should be delivered at rate of 40-60 breaths /min, maintain HR>100 /min Devices: BMV, ET (endotracheal tube),LMA(laryngeal mask airway)
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Bag & mask ventilation
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Endotracheal tube If BMV is ineffective/prolonged When chest compressions are performed Initial endotracheal suctioning of non vigorous meconium stained newborn
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Endotracheal tube
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LMA(Laryngeal mask airway) Soft mask, fits over laryngeal inlet when inflated, occludes the oesophageal opening Done when BMV is unsuccessful & tracheal intubation is unsuccessful or not feasible
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LMA(Laryngeal mask airway)
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Targeted SPO2 after birth
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Initial steps in resuscitation PPV
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AAP Algorithm
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Chest compressions Started when HR<60 per minute despite adequate ventilation with 100% oxygen for 30 sec Delivered at lower third of sternum, to depth 1/3 of AP diameter of chest 2 techniques: 2 thumb-encircling hands technique Compression with 2 fingers ,second hand supporting the back 3:1 ratio::[ 90 comp:30 ventilations]
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Initial steps of resuscitation PPV(ET) CHEST COMPRESSIONS
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AAP Algorithm
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Medications Rarely indicated Most important step to treat bradycardia is establishing adequate ventilation HR remains <60bpm,despite adequate ventilation(ET) with 100% Oxygen & chest compressions Epinephrine or volume expansion or both
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Epinephrine Route of administration: intravenous(IV),ideal Recommended dose: 0.01-0.03 mg/kg per dose Desired concentration: 1:10,000 0.1 mg/ml
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Volume expansion Suspected or known blood loss Isotonic crystalloid solution ; normal saline Blood Dose calculation: 10 ml/kg
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The golden minute <30 seconds: complete initial steps Warmth Drying Clear airway if necessary Stimulate 30-60 seconds: assess 2 vital characteristics Respiration (apnea/gasping/labored/unlabored) Heart rate (<100/>100bpm) Golden Minute Project: skill based training
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AAP Algorithm
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Post resuscitation care Needed for those who required PPV At risk of deterioration Hypo/hyperthermia ,hypoglycemia, CNS complications(apnea, HIE), pulmonary complications(TTN, Pneumonia), hypotension Need monitoring ,evaluation NICU may be necessary
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NNR : not indicated Conditions with certainly early death Extreme prematurity(GA<23 weeks) Birth weight<400g Anencephaly Chromosomal abnormality: Trisomy 13
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NNR: nearly always indicated High rate of survival Acceptable morbidity GA≥ 25 weeks Those with most congenital malformations
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NNR? Conditions associated with uncertain prognosis Survival borderline Parental desires concerning initiation of resuscitation should be supported
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Discontinuing resuscitative efforts Newborn with no detectable heart rate, consider stopping NNR if the heart rate remains undetectable for 10 minutes
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Summary Most infants transfer from intrauterine to extra uterine life 10% need some intervention,1% need extensive resuscitation Anticipate the need for NNR Adequate preparation for NNR Evaluate the newborn as per AHA/AAP guidelines & follow the recommended protocol
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MCQ1 For successful neonatal resuscitation following is/are needed except: Anticipation Adequate preparation Skilled personnel Delayed initiation of support
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MCQ1 For successful neonatal resuscitation following is/are needed except: Anticipation Adequate preparation Skilled personnel Delayed initiation of support
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MCQ2 Following are true in relation to initial steps of neonatal resuscitation except Provide warmth Tactile stimulation Endotracheal intubation Drying the baby
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MCQ2 Following are true in relation to initial steps of neonatal resuscitation except Provide warmth Tactile stimulation Endotracheal intubation Drying the baby
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MCQ3 The following is the primary measure of adequate ventilation Chest wall movement Improvement in heart rate Pink extremities Spo2 of 100%
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MCQ3 The following is the primary measure of adequate ventilation Chest wall movement Improvement in heart rate Pink extremities Spo2 of 100%
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MCQ4 Endotracheal intubation may be indicated at several points during neonatal resuscitation except Ineffective BMV During chest compressions Vigorous meconium stained newborn Non vigorous meconium stained newborn
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MCQ4 Endotracheal intubation may be indicated at several points during neonatal resuscitation except Ineffective BMV During chest compressions Vigorous meconium stained newborn Non vigorous meconium stained newborn
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MCQ5 The recommended compression to ventilation ratio in neonatal resuscitation is 2:1 3:1 4:1 5:1
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MCQ5 The recommended compression to ventilation ratio in neonatal resuscitation is 2:1 3:1 4:1 5:1
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MCQ6 The recommended dose(mg/kg per dose) and route of epinephrine in neonatal resuscitation 0.01-0.03,IV 0.01-0.03,IM 0.03-0.05,1V 0.05-0.1,IV
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MCQ6 The recommended dose(mg/kg per dose) and route of epinephrine in neonatal resuscitation is 0.01-0.03,IV 0.01-0.03,IM 0.03-0.05,1V 0.05-0.1,IV
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MCQ7 Recommended method/clinical indicator of confirming ET placement is Condensation in ET Chest movement Equal breath sounds on auscultation Exhaled C02 Detection
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MCQ7 Recommended method/clinical indicator of confirming ET placement is Condensation in ET Chest movement Equal breath sounds on auscultation Exhaled C02 Detection