Morning Report: 8/17/2012

Assigned Roles

*** Activate Proper NICU Personnel Response***

Resusitation Priorities: ** Different than with adults***

Drying, Warming, Positioning

BVM, Vent

Oxygen

Chest Compressions

Intubation

Medications

Pearl: Hypoxia and Hypothermia are the enemy

Drying, Warming: Have radiant warmer ready

Polyethylene plastic wrap if available

Warming pad underneath towels on resus tables

Goal Room Temperature: 250C to 260C (770F-790F)

Ventilation: Have correct BVM and mask, correct ET tube
Slight extension at the neck

BVM Indications:

Apnea or gasping respirations

HR < 100

Persistent Cyanosis despite O2

Assisted Rate= 40 to 60

Indications for Intubation:

BVM Ventilation Not Effective

Thick Meconium

Prolonged Positive Pressure Ventilation

Chest Compressions:

Indications for Chest Compressions:

Despite Adequate Stimulation and Effective Ventilation with 100% O2: HR < 60 or HR 60-80 but not increasing

Chest Compressions: Rate 90 per minute, Interposed by Vent

Compression Ventilation Ratio: 3:1

Stop compressions when HR> 80

Chest Compression Methods:

• Two finger Chest Compressions (Just Below Nipple Line)
• Hands-Around-the-Chest Compressions (2 Thumbs at Nipple Line) – Preferred

Depth: 1/3 the diameter of the chest

Medications:

Epinephrine: 1:10,000

Indications: HR< 80 despite PPV and Chest Compressions

Dose: 0.01 -0.03 mg/kg IV, ET, IO [0.1-0.3 mL/kg 1:10,000)

*Can give higher dose via ET tube (↓ reliablity but may be easiest access)

Nalaxone:

Indications: Respiratory Depression with history of maternal narcotic exposure within 4 hours of delivery

Dose: 0.1 mg/kg IV, ET, IO, SQ

Warning: May cause Acute Withdrawal Symptoms in infants of chronically addicted mothers

Work up: Acid-Base Status, Blood Glucose, Labs, CXR

Emergency Volume expansion: Isotonic Crystalloid or O negative RBC’s

Umbilical Line placement:

– May be live saving access in a neonate

– The umbilical vein remains patent and viable for cannulation until approximately 1 week after birth

Size: < 1500 g –> 3.5 F, 1500-3500 g –> 5F

Distance (cm): 5.5 X 1.5 BW(kg)

Umbilical Catheter Pearls:

-Very small premies (500 g), this means 6-6.5 cm

Additional Pearls:

If heart rate is still below 60 bpm despite 30 seconds of effective positive- pressure ventilation, increase the oxygen concentration to 100% and begin chest compressions.

Intubation is strongly recommended when chest compressions begin to help ensure effective ventilation.

Interruption of chest compressions to check the heart rate may result in a decrease of perfusion pressure in the coronary arteries. Therefore, continue chest compressions and coordinated ventilations for at least 45-60 seconds before stopping briefly to assess the heart rate.

If you anticipate the need to place an emergency umbilical venous catheter, continue chest compressions by moving to the head of the bed (near the infant’s head) and continuing the 2- thumb technique. This is most easily accomplished if the newborn is intubated.

Epinephrine is indicated when the heart rate remains below 60 bpm after 30 seconds of effective assisted ventilation (preferably via endotracheal tube) and at least another 45-60 seconds of coordinated chest compressions and effective ventilation.