Principles of Resuscitation

The Apgar score (T§b!e,..9-1) is assessed at 1 and 5 min of age for every newly delivered infant. Although the scoring system has been useful in evaluating the condition of the newborn, 1 min is too long to wait to make the decision to initiate resuscitation. If the 5-min score is less than 7, additional scores are obtained every 5 min for a total of 20 min.

TABLE 9-1 Apgar Score

Perinatal asphyxia is currently defined as the presence of the following: umbilical artery acidemia (pH <7.00), 5-min Apgar score of 0 to 3, neonatal neurologic sequelae, and multiorgan dysfunction. Certain conditions require specific measures during resuscitation in addition to those outlined below. These conditions are discussed following the general principles.

Resuscitation should be continued for a maximum of 30 min. Neonatal morbidity and mortality rates are high after 20 to 30 min of cardiac asystole and resulting encephalopathy in term infants. Infants who were successfully resuscitated at birth should have continuous monitoring of vital signs, blood gases, hematocrit, dextrose levels, blood pressure, fluid status, and clinical condition. Complications associated with severe asphyxia are seizures, hypoxic-ischemic encephalopathy, intracranial hemorrhage, inappropriate antidiuretic hormone (ADH) secretion, hypocalcemia, persistent pulmonary hypertension, ischemic cardiomyopathy, hypovolemia or shock, necrotizing enterocolitis, renal failure, and coagulopathy.

EQUIPMENT The following is a list of the equipment necessary for resuscitation.

1. Bag and mask with manometer attached, connected to a source of 100 percent oxygen (oxygen should be heated and humidified; bag should be a rubber anesthesia bag, a rebreathing bag of 500-mL capacity, or a self-inflating bag designed for newborns)

2. Rubber face masks of varying sizes, 1, 2, 3, and 4

3. Wall suction, sterile catheters, and bulb syringes

4. DeLee suction catheter with mucus trap

5. Laryngoscope with 0 and 1 blades

6. Oral endotracheal tubes with stylet, sizes 2.5, 3.0, 3.5, and 4.0 mm

7. Radiant heater with servomechanism

8. Sterile umbilical vessel catheterization tray

9. Glucose oxidase blood test strips

10. Heart rate monitor with easily applicable leads

11. Intravenous infusion equipment

12. Transcutaneous oxygen monitor or saturation pulse oximeter

13. Appropriate light

14. Infant stethoscope

15. Nasogastric tubes, 5F and 8F

16. Clock with sweep second hand

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