Resuscitation of newborns: indications, types, stages, medications

According to statistics, every tenth newborn child is provided with medical care in the maternity ward, and 1% of all those born need a full range of resuscitation. The high level of training of medical personnel can increase the chances of life and reduce the possible development of complications. Adequate and timely resuscitation of newborns is the first step to 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 methods;
• the use of mechanical ventilation;
• installation of a pacemaker, etc.

Full-term children do not require resuscitation. They are born active, scream loudly, heart rate and heart rate are within normal limits, the skin is pink in color, the child responds well to external stimuli. Such children are immediately placed on the mother’s stomach and covered with a dry, warm diaper. From the respiratory tract, the mucous contents are aspirated to restore their patency.

Cardiopulmonary resuscitation is considered emergency care. It is performed in case of respiratory arrest and heart function. After such an intervention, in the case of a favorable result, the basics of intensive care are used. Such treatment is aimed at eliminating possible complications of stopping the work of important organs.

If the patient cannot independently maintain homeostasis, then resuscitation of the newborn includes artificial lung ventilation (mechanical ventilation) or the setting of a pacemaker.

What is needed for resuscitation in the delivery room?

If the need for such events is small, then they will require one person. In the case of a severe pregnancy and the expectation of a full range of resuscitation, two specialists are in the maternity ward.

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

1. It is necessary to connect a heat source so that the resuscitation table and diapers are warmed up, one diaper is rolled up in the form of a roller.
2. Check if the oxygen supply system is installed correctly. There should be enough oxygen, properly adjusted pressure and feed rate.
3. You should check the availability of equipment that is required to aspirate the contents of the respiratory tract.
4. Prepare tools to eliminate gastric contents in case of aspiration (probe, syringe, scissors, fixing material), meconium aspirator.
5. Prepare and verify the integrity of the resuscitation bag and mask, as well as the intubation kit.

The intubation kit 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:

• resuscitation team accessibility - resuscitation specialists must be present at all births;
• coordinated work - the team should work in concert, complementing each other as one big mechanism;
• qualified employees - each resuscitator must have a high level of knowledge and practical skills;
• work taking into account the patient’s reaction - resuscitation should begin immediately when they become necessary, further measures are carried out depending on the reaction of the patient’s body;
• equipment health - equipment for resuscitation should be operational and accessible at any time.

Reasons for the need for events

The etiological factors of inhibition of the work of the heart, lungs and other vital organs of the newborn include the development of asphyxia, birth injuries, the development of congenital pathology, toxicosis of infectious genesis and other cases of unknown etiology.

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

The need for such events may appear in the following conditions:

• polyhydramnios or oligohydramnios;
• repotting;
• maternal diabetes;
• hypertonic disease;
• infectious diseases;
• fetal malnutrition.

There are also a number of factors that already arise during childbirth. If they appear, one can expect the need for resuscitation. Such factors include bradycardia in a child, cesarean section, premature and rapid delivery, placenta previa or detachment, uterine hypertonicity.

Asphyxia of the newborn

The development of respiratory disorders with hypoxia causes the appearance of disorders of the circulatory system, metabolic processes and microcirculation. Then there is a disorder in the work of the kidneys, heart, adrenal glands, and the brain.

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

• hypoxia;
• impaired airway (aspiration with blood, mucus, meconium);
• organic brain damage and central nervous system function;
• malformations;
• insufficient surfactant.

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

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

Status Assessment Sequence

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

How is primary resuscitation performed?

Be sure to wash and treat your hands with an antiseptic, wear sterile gloves. The child’s birth time is fixed, after the necessary measures are taken, it is documented. A newborn is placed under a heat source, wrapped in a dry warm diaper.

To restore airway patency, you can lower the head end and put the child on his left side. This will stop the aspiration process and allow the contents of the mouth and nose to be removed. Gently aspirate the contents without resorting to the deep introduction of an aspirator.

If such measures do not help, resuscitation of the newborn continues by reorganizing the trachea using a laryngoscope. After the appearance of breathing, but the absence of its rhythm, the child is transferred to mechanical ventilation.

The department of resuscitation and intensive care of newborns takes the child after the initial resuscitation measures to provide further assistance and maintenance of vital functions.

Lung ventilation

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 breathing;
• persistent cyanosis during normal functioning of the respiratory and cardiovascular systems.

This set of measures is carried out using a mask or bag. The head of the newborn is thrown back a little and a mask is applied to the face. It is held by index fingers and thumbs. The rest remove the jaw of the child.

The mask should be on the chin, nose and mouth. It is enough to ventilate the lungs with a frequency of 30 to 50 times in 1 minute. Bag ventilation can cause air to enter the stomach. You can remove it from there with the help of a gastric tube.

To monitor the effectiveness of the conduct, it is necessary to pay attention to the rise of the chest and the change in heart rate. The child continues to be monitored until the respiratory rhythm and heart rate are fully restored.

Why and how do they intubate?

Primary resuscitation of newborns also includes tracheal intubation, in case of mechanical failure for 1 minute. The right choice of tube for intubation is one of the important points. It is done depending on the body weight of the child and his gestational age.

Intubation is also carried out in the following cases:

• the need to remove aspiration of meconium from the trachea;
• continuous ventilation;
• facilitation of manageability by resuscitation measures;
• administration of adrenaline;
• deep prematurity.

On a laryngoscope, they turn on the light and take it in the left hand. Hold the head of the newborn with his right hand. 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 the glottis. The tube for intubation is inserted 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 up to the planned mark.

The laryngoscope is removed, then the conductor. The correct insertion of the tube is checked by compressing the breathing bag. Air enters the lungs and causes a chest excursion. Next, the oxygen supply system is connected.

Indirect cardiac massage

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

There are two ways to perform indirect massage. When using the first, pressure on the chest is carried out using the index and middle fingers of one hand. In another embodiment, massage is performed with the thumbs of both hands, and the remaining fingers are involved in supporting the back. A resuscitator-neonatologist presses on the border of the middle and lower third of the sternum so that the chest cage bends 1.5 cm. The frequency of clicks is 90 per minute.

It is imperative to ensure that inhalation and pressure on the chest are not carried out simultaneously. In the pause between pressing, you can not remove your hands from the surface of the sternum. Pressing the bag is done after every three pressures. For every 2 seconds you need to carry out 3 pressures and 1 ventilation.

Actions for contamination of water with meconium

Features of resuscitation of newborns include assistance in staining amniotic fluid with meconium and assessing a child on an Apgar scale of less than 6 points.

1. In the process of childbirth, after the appearance of the head from the birth canal, immediately aspirate the contents of the nasal cavity and mouth.
2. After giving birth and placing the baby under a heat source, before the first breath it is advisable to intubate with the largest possible size tube to extract the contents of the bronchi and trachea.
3. If you can extract the contents and it has an admixture of meconium, then you need to re-intubate the newborn with another tube.
4. Ventilation is established only after all contents have been extracted.

Drug therapy

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

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

Adrenaline is injected through the endotracheal tube into the trachea or into a vein jet. The concentration of the drug is 1:10 000. The drug is used to increase the force of contraction of the heart and accelerate heart rate. After endotracheal administration, mechanical ventilation is continued so that the drug can be evenly distributed. If necessary, the drug is administered after 5 minutes.

Calculation of the dose of the drug 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.

In case of blood loss or the need to replenish the volume of circulating blood, albumin, physiological sodium chloride solution or Ringer's solution are used. The drugs are injected into the vein of the umbilical cord jet (10 ml per 1 kg of body weight of the child) slowly over 10 minutes. The introduction of BCC replenishes allows you to increase blood pressure, reduce acidosis, normalize heart rate and improve tissue metabolism.

Resuscitation of newborns, accompanied by effective ventilation of the lungs, requires the introduction of sodium bicarbonate into the umbilical vein to reduce signs of acidosis. The drug can not be used until adequate ventilation of the child is established.

Dopamine is used to increase cardiac index and glomerular filtration. The drug dilates the vessels of the kidneys and increases the clearance of sodium when using infusion therapy. It is administered intravenously micro-jet under constant monitoring of blood pressure and heart rate.

Naloxone is administered intravenously 0.1 ml of the drug per 1 kg of body weight of the child. The tool is used when the skin color and pulse are normal, but there are signs of respiratory depression. A newborn should not be given naloxone when the mother uses drugs or undergoes treatment with narcotic analgesics.

When to stop resuscitation?

Mechanical ventilation continues until the child scores 6 points on Apgar. Such an assessment is carried out every 5 minutes and lasts up to half an hour. If after this time the newborn has an indicator of less than 6, then he will be transferred to the ICU of the maternity hospital, where further resuscitation, intensive care of the newborn is carried out.

If the effectiveness of resuscitation measures is completely absent and asystole and cyanosis are observed, then the measures last up to 20 minutes. When at least the slightest signs of effectiveness appear, their duration increases for the whole time until the measures give a positive result.

Resuscitation department of newborns

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

After resuscitation, a newborn needs to prevent the occurrence of cerebral edema or other central nervous system disorders, restore kidney function and excretory function of the body, and normalize blood circulation.

The child may appear metabolic disorders in the form of acidosis, lactic acidosis, which is due to violations of peripheral microcirculation. From the side of the brain, the appearance of convulsive attacks, hemorrhage, cerebral infarction, edema, the development of a coma. Dysfunctions of the ventricles of the heart, acute renal failure, atony of the bladder, adrenal insufficiency and other endocrine organs may also appear.

Depending on the condition of the baby, he is placed in a couvez or oxygen tent. Specialists monitor the work of all organs and systems. The baby is allowed to feed only after 12 hours, in most cases through a nasogastric tube.

Errors not permitted

It is strictly forbidden to carry out activities whose safety has not been proven:

• pour water on the baby;
• squeeze his chest;
• strike on the buttocks;
• direct an oxygen stream into the face and the like.

A solution of albumin cannot be used to increase the initial bcc, since this increases the risk of death of the newborn.

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