Statistics:
Neonatal mortality rate (NMR) of Pakistan is 36/1000 live births (as of April, 2026)
Total yearly births 6.9 million
Total yearly neonatal deaths 259,000
Births attended by skilled birth attendant 68 %
Deaths from birth asphyxia 20.9 % (50,000 per year)(1/5th of total deaths)
Preterm 40% what? deaths?
Every birth should be attended by a skilled birth attendant.
If 2 babies are expected, 2 teams should be available to resuscitate.
Every high-risk birth should be attended by 2 skilled birth attendants with their team.
85% babies cry spontaneously after birth
10% more cry after drying/stimulating
~5% breather with PPV
<1% need ETT
<0.1 % need chest compressions or adrenaline
Preparation:
Identify team leader
Assign roles to the team members and brief the team
Review case history and antenatal risk factors
Counsel family
Prepare environment, mother's hands, chest and abdomen
perform hand hygiene, wear gloves, and check equipment
At birth:
Note time of birth, Start timer.
Place sheet on abdomen of mother and place wet baby on that sheet
Dry - stimulate - Keep warm
Change the sheet, now place the baby on abdominal skin of mama, and put sheet on baby
If the baby breathes > give routine care
Breathing No? > Open airway - Clear airway if obvious secretions ......if still not breathing, cut the cord and move to resuscitation area and give 5 PPVs.
When a baby cries, you give cap
When a baby doesnt breathe, you open airway, clear airway if required, cut the cord, and move to resuscitation area and give 5 PPVs
If chest doest rise, you do MR SOPA
If chest rises, you check heart rate, every 30 seconds
If heart rate <60 you turn FiO22 100%, Pass ETT, and start chest compressions, attach cardiac monitor if not already attached.
If heart rate < 60 despite 60 seconds of chest compressions, you perform CARDIA, and give inj adrenaline UVC>IO>ETT>peripheral iv line. *If there is a time for passing UVC and ETT has already been passed, then give adrenaline per ETT.
Once the baby starts regular breathing during resuscitation, you give cap to the baby, and move the baby to neonatal unit for post resuscitation care that includes:
Family counselling , documentation of events, STABLE, and system wise monitoring.
STABLE
Sugar >45 mg/dL
Temperature
Airway
Breathing
Labs (ABGs)
Emotional support
Monitoring for brain, heart, respiratory system, gut, renal
Team briefing, and audit for continuous quality improvement (CQI)
Routine Care: (a crying baby)
Dry the baby, Give cap to the baby
Keep warm, skin to skin on mother's chest
Cut the cord at 1 minute
Encourage breast feeding within 1 hour of birth
Observe the baby for warmth, breathing.
Resuscitation of baby outside delivery room (in hospital ward, or outside hospital, or in a vehicle)
Safety (scene + safety from mother's secretions etc)
Call for help
Birth
Keep warm
Secretions can be cleared by wiping off with cloth
If inside hospital ward, baby may be given Oxygen via flow meter if required,
Transfer the baby to NICU as soon as possible
No comments:
Post a Comment