Pediatric emergency medicine trisk 0234 0234

ETT, endotracheal tube; UVC, umbilical vein catheter (Reprinted with permission Circulation 2015;132:S543–S560 © 2015 American Heart Association, Inc.) MANAGEMENT Newly born infants who meet all three of the following criteria not require immediate resuscitation Term gestation Good tone Breathing or crying These infants may stay with the mother for routine care, while maintaining ongoing observation of breathing, activity, and color until transfer to definitive care Routine healthy newly born care includes the following: dry the infant, place skin to skin with the mother, and cover in dry linen to prevent heat loss Newly born infants who not meet any of the above criteria should be placed on a radiant warmer and resuscitation steps initiated Figure 9.17 includes the steps in the Neonatal Resuscitation Algorithm, according to the 2015 AHA Guidelines Update Special attention should be paid to “the Golden Minute,” the first 60 seconds allotted to completing initial steps, reevaluating, and beginning ventilation if required Ventilation is the most important step for successful resuscitation of the newly born infant who has not responded to the initial steps of warming, clearing and repositioning the airway, drying, and stimulating Progression to subsequent steps is determined by simultaneous assessment of: Respirations (apnea, gasping, labored or unlabored breathing) Heart rate (less than 100/min) If PPV or supplemental oxygen is initiated, response is determined by simultaneous assessment of oxygen saturation along with the aforementioned respirations and heart rate Heart rate is the most sensitive indicator of successful response to each step in the Neonatal Resuscitation Algorithm