Meconium aspiration is done for 3 times but no breathing occurs. Next step in resuscitation would be-
Ans. is 'd' i.e., Trikling of sole To solve this question, one should know the resuscitation protocol of newborn. Resuscitation protocol o As soon as the baby is delivered, five signs are assessed ? Clearance of meconium Active breathing or crying Good muscle tone (flexed posture and active movement of baby). Pink color (look at tougue and lips) Term gestation (delivery between 37-42 weeks of pregnancy). o If all signs are positive no active resuscitation is required. o If any of the 5 signs is absent, baby requires resuscitation. o 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 1. Positioning 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 3/4 or 1 inch off the mattress. 2. Suctioning 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 inse the catheter very deep in mouth or nose for suction -4 Stimulation of posterior pharynx during the first few minutes after bih can produce a vagal responce, causing severe bradycardia or apnea. 3. Dry, stimulate and reposition After suctioning, the baby should be dried by using pre-warmed linen to prevent heat loss. A brief tactile stimulation in the form of flicking the soles or rubbing the back may be provided in case of non-establishment of good respiratory effos. 4. Free flow of oxygen If the baby continues to be depressed, provide free flow of oxygen using a facemask. After providing initial steps, the baby should be evaluated for three signs ? Respiration Hea rate (HR) Color If baby has good breathing, HR >100 and pink color, he should be given suppoive care. If the baby is not breathing well or HR o After the infant has received 30 seconds of ventilation with 100% oxygen by bag and mask, evaluation of hea rate should be done - HR >100 ----> Discontinue ventilation if spontaneous respiration is present HR 60 to 100 --> Continue ventilation Below 60 ---> Continue ventilation + chest compressions After 30 seconds of chest compressions, the hea rate is checked. HR HR> 60 Discontinue chest compression but continue bag & mask ventilation until the hea rate is above 100.
Chest compression
O2 inhalation
Bag & mask intubation
Trikling of sole