1. NEONATAL RESUSCITATION PRESENTED BY PHATTRAPONG TANSUPOL MD.

6. ASPHYXIA CHANGE

7. APGAR SCORE

8. Anticipation and Recognition of the Neonate in Distress 1. Antepartum and intrapartum history Abnormal presentation Operative delivery Premature labour Premature rupture of membranes Precipitous labour Prolonged labour Indices of fetal distress (FHR abnormalities, biophysical profile) Age > 35 years Maternal diabetes Pregnancy-induced hypertension Chronic hypertension Other maternal illness (e.g. CVS, thyroid, neuro) Previous Rh sensitization Drug therapy (e.g. magnesium, lithium adrenergic-blockers) Intrapartum Factors Antepartum Factors

9. 1. Antepartum and intrapartum history CONT. Maternal narcotics (within 4 hrs of delivery) General anaesthesia Meconium-stained fluid Prolapsed cord Placental abruption Placenta previa Uterine tetany Maternal substance abuse No prenatal care Previous stillbirth Bleeding - 2nd/3rd trimester Hydramnios Oligohydramnios Multiple gestation Post-term gestation Small-for-dates fetus Fetal malformations Intrapartum Factors Antepartum Factors

17. Resuscitation in the delivery room

21. METHOD

26. Drug dosage Give rapidly IV or ET preferred 0.1 m g/ kg 0.25ml/kg 0.1 ml/kg 1 ml 1 ml Naloxone 0.4 mg/ml 1.0 mg/ml Give IV over 5-10 min 10 m l/ kg 40 ml Volume Expanders -NS or RL -5% Albumin -O-neg Blood Give rapidly IV or ET Repeat q 3-5 min (ET: dilute to 1-2 ml with NS) 0.01-0.03 m g/kg 0.1-0.3 m l/ kg 1 ml Epinephrine 1:10,000 Rate/Precautions Dosage Preparation Drug

27. Drug dosage cont. Dopamine ( 6 x weight in kg = mg of dopamine diluted to 100 ml) Sodium Bicarbonate (0.5 mE q/ ml = 4.2% soln) Reserved for prolonged resuscitations only 100 ml 20 ml 10 mlx2 2 mE q/ kg ( 4 m l/ kg) Continuous infusion by pump Give slowly, over at least 2 min, IV ONLY, Infant must be ventilated