NEONATAL RESUSCITATION (Apgar Score)

  H ow R eady I s T his C hild? <--- (Apgar Score) Assess Apgar at 1, 5 minutes, if < 7 at 5 min then again 5 min ...

 

1. How Ready Is This Child? <--- (Apgar Score)

2. Assess Apgar at 1, 5 minutes, if < 7 at 5 min then again 5 min

Sign	0	1	2
Heart Rate	absent	< 100/minute	> 100/minute
Respiratory Effort	absent	slow, irregular	good, crying
Irritability	no response	grimace	cough or sneeze
Tone/Muscle	limp	some flexion of extremities	active motion
Color	blue, pale	body pink, extremities blue	completely pink

 

 

Initial Resuscitation

1. always remember ABC's
2. anticipation - know maternal history, history of pregnancy, labor, and delivery
3. all infants
   • prevent heat loss by drying, warming (on radiant heater, remove wet towels)
   • position head and neck to open airway for suction
   • stimulate infant
4. Airway
   • gentle suction of mouth then nose: < 100 mmHg, < 5 seconds
   • with thick meconium, suction the nasopharynx as the headis delivered, then intubate and suction trachea prior to first breath if possible
5. Breathing
• check for spontaneous respirations
• bag and mask if apneic/gasping/HR < 100, bag at a rate of 40-60/minute with 90-100% O2
• intubation is indicated if
• prolonged ventilation is required
• bag and mask are not effective
• tracheal suctioning is needed (thick meconium)
• HR remains < 100
• diaphragmatic hernia is suspected
6. Circulation
• heart rate is the most important indicator of the need for intervention
• "80 or less compress" - if bradycardic (apex < 80 and no improvement with bagging) or asystolic, compressions begin at rate of 120/minute
• coordinate 3 compressions with 1 ventilation (120 compressions/minute, 40 ventilations/minute) - check after 30 seconds
• if HR > 80 stop compressions but continue ventilation
7. Drugs
   • epinephrine - for asystole or severe bradycardia
   • HCO3 (4.2% solution given slowly)
   • CaCO3 - electrical abnormalities
   • Narcan (Naloxone) - if mother given opioids, general anesthetic