| When a baby is delivered it should give a loud & healthy cry within a few seconds. If it doesn’t then it will require immediate resuscitative and supportive measures. Care of Normal Baby – - Hold the baby and baby tray in a head low position till pharyngeal suction is done.
- quickly dry the baby, and wrap in a dry cloth(in a hospital, place it under a radiant warmer.) Prevention of body heat loss is very important. If baby is covered with vernix, do not rub it off, as it protects body heat.
- using a large bore (12F) suction catheter connected to a suction machine or suction bulb, suck all the ambniotic fluid & meconium from the pharynx and body nostrils.
- if by this time, baby has not cried, stimulate it by following methods:
i. tap it over the back or over the soles. ii. Sprinkle handful of water over the chest and abdomen. iii. Compress the chest 2-3 times. iv. If it breathing, but not crying continue stimulations intermittently till the baby cries. Try holding it upside down for 2 minutes. If the baby does not breath - Always suck the throat before giving artificial Breathing. Mouth to mouth breathing or bag & mask ventilation should be started within ½ to 1 minute, if spontaneous breathing is not seen.
- hold the head in a slightly extending position (Best achieved by placing a Towel under the shoulders.)
- place the mask covering the baby’s nose & mouth. Hold it tightly, with thumb & index finger pressing it against the face & other fingers lifting the mandible against the mask.
- press the bag 40 times per minute watching carefully for adequate chest expansion.
- connect Oxygen to the inlet of the Ambu bag.
- observe for spontaneous respirations & Heart rate.
- if bag & mask are not available, give mouth to mouth breathing.
- if stomach starts distending
- press a hand over the epigastrium to prevent air entering abdomen - pass a infant feeding the tube and keep it open, to let out air-from the stomach. - inject through umbilical cord veins-
- Inj. Sodabicarb 3-4 cc - Inj. Dopram 1/4cc - Inj. Decadron1/4-1/2cc If Heart rate is <60/minute or absent Start chest compressions immediately Encircle the chest with both palms keeping both thumbs over the middle third of the sternum. Press the thumbs, to depress the sternum by ½ to ¾ inch at a rate 120/min. Synchronise thechest compression with respiration by stopping momentarily after every 3 chest compressions, to inflate the chest by Ambu’s bag once. Stop periodically to check the femoral pulse. Continue chest compressions till Heart rate is >80/minte and regular. If heart does not respond and does not beat at all, inject 1/4cc adrenalin, intracardiac and continues chest compressions. If respiratory depression is prolonged, then do not continue mask bag respirations for long. Intubate immediately. Insert a laryngoscope with infact blade to visualize the larynx and insert a No.3 (or 3.5) endotracheal tube. The tube is passed 1-2 cms. Beyong the cords & then fixed in position. Connect it to the Ambu Bag and start artificial respiration. Confirm that the tube is in proper place. Both sides of the chest should expand equally. Air entry should be equal on both sides. If air entry is less on the left side, then with draw the tube slightly, till it is equal & good If Liquor is Meconium stained. 1. Suck the pharynx & nose, as so as head is out before delivering the shoulders. 2. Hold the baby in head low position. Insert laryngoscope, and suck the pharynx thoroughly. 3. intubate the trachea, and suck the lower trachea & bronchii with affine catheter. Or apply suction directly to the endotracheal tube, withdraw it – then introduce it again, connect suction & withdraw – till all meconium is sucked out. 4. insert a infant feeding tube, into the stomach, aspirate all meconium and wash the stomach with a few ml of half normal saline. 5. if mother had received Morphine/Pethidine. and the baby has repiratory depression. - inject Naloxone 0.1 mg/kg I.V. ie. ½ cc I.V. Repeat after 3 minutes if necessary. Inj. Dopram Inj. Sodabicarb DECDAN |
