Resuscitation of newborns

Approximately 10% of newborns need, to varying degrees, resuscitation during childbirth. The reasons for this are numerous, but most of them include asphyxia or respiratory depression. The frequency increases significantly when the birth weight is less than 1500 g.

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Surveys

The Apgar score from 0 to 2 points is set for each of the 5 indicators of the newborn's condition (appearance, pulse, reflexes, activity, respiration). Evaluation depends on the physiological maturity, treatment of the mother in the perinatal period and the drink cardiorespiratory and neurologic disorders in the fetus. The number of points from 7 to 10 in the 5th minute is estimated as normal; from 4 to 6 - moderately low and from 0 to 3 - low. A low Apgar score is not in itself a diagnostic criterion for perinatal asphyxia, but is associated with a risk of long-term neurological dysfunction. Unreasonably long (> 10 min) a persistent low score on the Apgar scale indicates an increased risk of death in the first year of life.

The earliest sign of asphyxia is acrocyanosis, followed by a violation of breathing, a decrease in muscle tone, reflexes and heart rate. Effective resuscitation first leads to an increase in the heart rate, followed by an improvement in the reflex response, color of the skin, respiration and muscle tone. Signs of fetal distress during childbirth, Apgar score from 0 to 3 points, pH of umbilical arterial blood less than 7, and neurologic syndrome in a newborn including hypotension, coma, convulsions and signs of multi-organ dysfunction are manifestations of perinatal asphyxia for more than 5 minutes . The severity and prognosis of posthypoxic encephalopathy can be assessed using the Sarnath classification in combination with EEG, auditory and cortical evoked potentials.

Resuscitation

Initial activities for all newborns include mucus suction and tactile stimulation. Suction of mucus from the oral cavity, nasal passages and pharynx should be performed immediately after birth, especially in newborns in the presence of meconium in the amniotic fluid, and then carried out intermittently, avoiding deep sanation of the oropharynx. For suction of mucus, properly sized catheters and a pressure limitation of up to 100 mm Hg are required. (136 cm H2O). Tactile stimulation (for example, patting the plantar surface of the feet, stroking the back) may be necessary to establish spontaneous regular breathing. Newborns who do not have adequate breathing and heart rate require O2 administration, ventilation through a mask using the Ambo bag, sometimes intubation of the trachea, and much less closed heart massage.

The child is quickly wiped with a dry warm diaper and placed under a radiant heat source in the position on the back. The neck is supported in the middle position by means of a folded towel, placed under the shoulders.

Oxygenotherapy is carried out at a rate of 10 liters / minute through an oxygen mask attached to a self-inflating or anesthetic bag; if there is no mask, you can use an oxygen tube located next to the person and supplying oxygen at a speed of 5 liters per minute. If there is no spontaneous breathing or the heart rate is less than 100 per minute, use auxiliary ventilation through the mask using the Ambo bag. The presence of bradycardia in a child with RDS is a sign of menacing cardiac arrest; the newborns tend to develop bradycardia with hypoxemia.