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Neonatal life support - Coggle Diagram
Neonatal life support
Definition
The primary aim is to inflate the lungs so that the still functioning circulation can pump oxygenated blood to and from the heart to initiate recovery
Incidence rates
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10% respond after drying, tactile stimulation and opening the airway
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Physiology
All foetuses experience hypoxia in birth, with respiratory exchange interrupted for 50-75 seconds with each contraction
Most healthy foetuses can cope with this well as the neonatal brain can survive without oxygen for much longer than the adult brain
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Primary apnoea
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If hypoxia becomes severe enough at birth, fetal breathing movements become deeper and more rapid and eventually cease as the brainstem cannot cope without oxygen
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Lactic acid build up means that fetal blood becomes acidotic and circulation is diverted from non vital organs
Terminal apnoea
After a variable period of time, the foetus makes shuddering whole body gasping movements at 12 per minute
If this fails to aerate the lungs, breathing ceases all together
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Without treatment, the baby will die
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Thermal control
After birth, babies temperature needs to be monitored regularly and the admission temp needs to be recorded
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Hypothermia (under 36) and hyperthermia (over 38) needs to be avoided. Therapeutic hypothermia may be indicated in some circumstances
How to keep a baby warm
Over 32 weeks
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Cover the babies head and body with a towel, leave the chest out for resus
Skin to skin can be facilitated if no resus needed, with a towel placed over the top
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If resus is needed, place baby on a warmed surface with a radiant heater
Under 32 weeks
Cover completely, apart from face, with polythene wrapping and without drying place under a radiant heater
If cord clamping is delayed and a radiant heater is not available, other measures need to be in place to ensure thermal stability
Further interventions include, increased room temp, warm blankets, head caps and thermal mattress
Skin to skin can be facilitated with less mature infants however caution needs to be taken with infants who are very pre term of growth restricted to avoid hypothermia
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Initial assessment
Should ideally take place before cord is clamped : colour, tone, breathing, heart rate
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Tactile stimulation : initial handling is an opportunity to stimulate by drying the infant (can rub soles of feet or back). Do not use aggressive methods of stimulation
Tone and colour. Very floppy infants most likely will need respiratory support. Colour is a poor way of assessing oxygenation as cyanosis can be difficult to diagnose but pallor can indicate shock or hypovalaemia, consider fluid loss
Breathing : rate, depth and symmetry. Work/effort of breathing as adequate, inadequate/abnormal pattern eg gasping or absent
Heart rate : with stethoscope and SATS machine. Fast (over 100), slow (60-100), very slow (under 60)
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Starting resus
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if heart rate is under 100 or adequate or regular breathing has not been established within 90-120 seconds
Opening the airway, aerating and ventilation the lungs is often all that's needed. without these steps, any other interventions will not be successful
Airway
Place the baby on its back and support head in a neutral position, may need shoulder support if prominent occiput
In floppy infants, jaw thrust may be needed to open or maintain the airway and reduce mask leak. 2 person method is superior
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OPA airway can be used to secure airway but associated with increased obstruction in infants under 34 weeks. Size from corner of the mouth to the jaw
NPA can be used to secure airway if having difficulties securing airway and mask support is unable to achieve aeration
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Inflation breaths
If the baby is apnoeic, gasping or not breathing effectively, aim to start positive pressure ventilation within 60 seconds
Apply fitted face mask attached to positive pressure ventilation. Ensure good mask seal by using the align, roll and check technique. Should not be covering the eyes but covering the chin and squeezing the nose
Should give 5 inflation breaths, maintaining the inflation pressure for 2-3 seconds. Forces the fluid out of the lungs
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Reassess
Check heart rate
If heart rate has improved within 30 seconds or it is stable if initially over 100, this confirms adequate inflation pressure
if the heart rate if slow or very slow this suggests hypoxia and almost always indicated inadequate inflation pressure
Check chest movement
If there is visible chest movements with inflations, this confirms patent airway and delivered volume
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Also check breathing, tone and colour
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Ventilation
if there is heart rate/chest movement improvement but baby is still not breathing adequately on their own
30 ventilation breaths per minute, maintaining inflation pressure for 1 second
If the chest is moving well, reduce inlfation pressure
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Chest compressions
if the heart rate is below 60 after 30 seconds of good quality ventilation, start chest compressions
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3 compressions to 1 ventilation breath at 15 cycles, every 30 seconds. Need to allow enough time between compressions for oxygenated blood to flow from the lungs to the heart
Two handed technique, Grasp the baby with both hands and with both thumbs press down 1/3rd into the lower third of the sternum, just below the nipple line with the fingers on the back at the spine
If the heart rate is below 60 after 30 seconds of chest compressions, continue but ensure airway is secured. If heart rate is above 60 but baby still not breathing on their own, ventilation breaths
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Drugs
If heart rate is still below 60 after opening airway, ventilation and chest compressions
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