Meconium aspiration is done for 3 times but no breathing occurs. Next step in resuscitation would be- (LQ)
|C||Bag & mask intubation|
|D||Trikling of sole|
Trikling of sole
To solve this question, one should know the resuscitation protocol of newborn,
a. As soon as the baby is delivered, five signs are assessed -
i. Clearance of meconium
ii. Active breathing or crying
iii. Good muscle tone (flexed posture and active movement ofbaby).
iv. Pink color (look at tongue and lips)
v. Term gestation (delivery between 37-42 weeks ofpregnaacy).
b. If all signs are positive no active resuscitation is required.
c. If any of the 5 signs is absent, baby requires resuscitation.
d. The baby should be placed under the heat source (radiant warmer) and subjected to a set of intervention known as initial steps.
Initial steps of resuscitation
• The neonate should be placed on her back or side with the neck slightly extended.
• This can be achieved by putting a rolled blanket or towel under the shoulders, elevating them % or I inch off the mattress.
• The mouth and nose should be suctioned
• The mouth is suctioned first to ensure that there is nothing for the infant to aspirate when the nose is suctioned.
• One should not insert the catheter very deep in mouth or nose for suction -J Stimulation oI postetior pharynx duing the frstfew minutes after birth can produce a vagal responce, causing severe bradycardia of apneo.
iii. Dry, stimulate and reposition
• After suctioning, the baby should be &ied by using pre-warmed linen to prevent heat loss.
• A brieftactile stimulstion in the form offlickins th solcs or rubbinq the brck mav be provided in case of tron-establisbment of qood resoiratory efforts.
iv. FYee flow ofoxygen
• If the baby continues to be depressed, provide free flow of ox.vgen using a facemask.
e. After providing initial steps, the baby should be evaluated for three signs -
ii. Heart mte (HR)
f. If baby has good breathing, HR >100 and pink color, he should be given supportive care.
g. Lf the baby is not breathing well or HR <100 then bag and mask yentilation is needed,
h. After the infant has received 30 seconds ofventilation with I 00ob oxygen by bag and mask, evaluation ofheaxt rate
i. should be done -
HR>100 -, Discontinue ventilation if spontaneous respiration is present
HR60 to 100 -, Continue ventilation
Below 60 -+ Continue ventilation + chest compressions
j. After 30 seconds ofchest compressions, the heart rate is checked.
IIR< 60 -+ Continue chest compression and bag & mask ventilation + initiate medications.
IIR> 60 -, Discontinue chest compression but continue bag & mask ventilation until the heaxt rate is above 100.