At birth, a normal baby is active and alive. Has spontaneous breathing, cries. Heart rate is around 120 - 140/min and cyanosis resolves quickly. However, some babies may need resuscitation. The earliest Apgar score is I. Since it is checked every minute, the start of resuscitation cannot be decided according to APGAR. However, the APGAR score can be used to evaluate the effectiveness of resuscitation procedures in the following minutes. Premature babies are more difficult to resuscitate. Because they are power ventilated and difficult to heat.
ABC's of Resuscitation
• Airway: Opening the airway
• Breathing· Starting breathing
• Circulation: Ensuring circulation
Drugs used in neonatal resuscitation
Adrenaline 1/10,000
Expanders :Ringer lacta
Sodium bicarbonate
• Appropriate tactical stimuli to initiate respiration at the beginning are smacking the soles of the feet, flicks and back pats. Tactical warnings such as hitting the back, dilation of the anal sphincter, compression of the rib cage, hot or cold compress-bath, pushing the legs towards the abdomen, cold oxygen to the face or body are wrong and harmful applications.
• In resuscitation, resuscitation should be started with an oxygen concentration of 21% in babies born at 2::35 weeks, while babies born at <35 weeks should start with an oxygen concentration of 21-30%. The concentration should be adjusted according to the patient's needs. It is not recommended to start with a 100% oxygen concentration, but 100% oxygen can be used initially in cases where pulmonary hypertension is suspected (such as meconium aspiration syndrome, diaphragmatic hernia).
• If necessary, in advanced stages of resuscitation, newborns should be given 90 compressions and 30 ventilations in 1 minute, and 1 ventilation for every 3 compressions.
• If the baby has severe respiratory depression and the mother has been given a narcotic within the last 4 hours, a narcotic antagonist is used. Narcan (narcotic antagonist) is contraindicated as it can cause acute withdrawal syndrome and severe convulsions in infants of opiate dependent mothers.
• According to the latest neonatal resuscitation recommendations, direct intubation is not necessary in infants with meconium in the amniotic fluid if there are no signs of airway obstruction, even if they are clinically depressed.
situation in which resuscitation by direct intubation should be applied in newborn resuscitation
1. Congenital diaphragmatic hernia
2. Very low birth weight premature baby