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Problems of the neonate and young infant Neonatal resuscitation

Chapter3

Case study: Chan

Baby Chan is born at term. He is blue and has poor muscle tone. He doesn't cry.

Routine care of the newborn at delivery


Dry baby with clean cloth and place where the baby will be warm

Look for:
Breathing or crying Good muscle tone Colour pink

NO
NO NO

Start the resuscitation now!

Neonatal resuscitation (A)


Open airway by positioning the head in the neutral position (Ref. p. 47)

Clear airway, if necessary


Stimulate, reposition Give oxygen, as necessary

Baby Chan is still blue and not breathing.

Neonatal resuscitation (B)


Use a correctly fitting mask:

Give the baby 5 slow ventilations with bag (Ref. p. 47-49)

Observe the baby closely!

Neonatal resuscitation (C)


Baby Chan starts breathing

But if the baby is still not breathing (Ref. p. 47) :


Check position and mask fit:

Check the heart rate Continue to bag at rate of about 40 breaths per minute Use oxygen if available Every 1-2 minutes stop and see if the pulse or breathing has improved.

History
Baby Chan was born at term. He came out not crying, blue and with poor muscle tone. He was reanimated for 2 minutes. Rupture of membranes happened at home, contractions were regular. His mother was in labour for a long period of time, but progressed to normal delivery in hospital. No chronic illness and no preeclampsia were diagnosed before. Chan is her first baby.

Examination after stabilisation


After 2 minutes resuscitation baby Chan was breathing normally, muscle tone has increased. He was crying. Vital signs: pulse: 140/min, RR: 50/min Weight: 3,2 kg Chest: air entry was good bilaterally and there were no added sounds, no chest indrawing was noticed Cardiovascular: both heart sounds were audible and there was no murmur Abdomen: soft, bowel sounds were active Neurology: muscle tone middle, no focal signs

What supportive care and monitoring are required?

Monitoring
The newborn has to be monitored frequently Pay attention to child's breathing, muscle tone and ability to drink

Monitoring (continued)
In the days after birth the newborn may develop following problems (Ref. p. 51-52):
Convulsions check glucose treat with phenobarbital Apnoea oxygen by nasal catheter resuscitation with bag and mask Inability to suck feed with milk via a nasogastric tube

Treat only if the problems arise

Supportive Care
If none of the problems described arise provide supportive care as for the normal newborn:
Give the baby to mother as soon as possible, place on chest or abdomen Cover the baby to prevent heat loss Encourage initiation of breastfeeding within the first hour Keep umbilical cord clean and dry Give vitamin K (phytomenadione), according to national guidelines 1 ampoule IM once Apply antiseptic ointment or antibiotic eye drops (e.g. tetracycline) to both eyes once (prophylaxis), according to national guidelines (Ref. p. 46, p. 50)

Breastfeeding support
Early and exclusive breastfeeding is very important for all newborns.

Breastfeeding support:

Encouragement Breastfeeding friendly environment Breastfeeding, assessment and counselling (Ref. p. 295)

Progress
Chan's motor tone has recovered well. After his mother was encouraged and counselled in breastfeeding, he started to suck. After some difficulties at the beginning he was sucking well. Before he was discharged home he also received oral polio, hepatitis B and BCG vaccines.

Follow-up
Baby Chan should receive regular clinical follow-up at first-level facilities to monitor: His clinical condition Growth Nutritional intake Immunization status

Summary
Be prepared for resuscitation at every delivery. Learn all steps of neonatal resuscitation by heart and train them whenever it is possible. Prognosis for the baby with perinatal asphyxia can be predicted by recovery of motor function and sucking ability. The prognosis is good for babies who respond quick to resuscitation. It is worse, if the baby has not recovered motor function and cannot suck spontaneously.