Textbook of Neonatal Resuscitation, 7th Edition

Foundations of Neonatal Resuscitation What you will learn ■ Why neonatal resuscitation skills are important ■ Physiologic changes that occur during and after birth ■ The format of the Neonatal Resuscitation Program® ...

Foundations of Neonatal Resuscitation What you will learn ■ Why neonatal resuscitation skills are important ■ Physiologic changes that occur during and after birth ■ The format of the Neonatal Resuscitation Program® Flow Diagram ■ Communication and teamwork skills used by effective resuscitation teams Why do newborns require a different approach to resuscitation than adults? Most often, adult cardiac arrest is a complication of trauma or existing heart disease. It is caused by a sudden arrhythmia that prevents the heart from effectively circulating blood. As circulation to the brain decreases, the adult victim loses consciousness and stops breathing. At the time of arrest, the oxygen and carbon dioxide (CO2) content of blood is usually normal. During adult cardiopulmonary resuscitation, chest compressions are used to maintain circulation until electrical defibrillation or medications restore cardiac function. In contrast, most newborns requiring resuscitation have a healthy heart. When a newborn requires resuscitation, it is usually caused by a problem with respiration leading to inadequate gas exchange. Respiratory failure may occur either before or after birth. Before birth, fetal respiratory function is performed by the placenta. If the placenta is functioning normally, oxygen is transferred from the mother to the fetus and CO2 is removed. When placental respiration fails, the fetus receives an insufficient supply of oxygen to support normal cellular functions and CO2 cannot be removed. The blood level of acid increases as cells attempt to function without oxygen and CO2 accumulates. Fetal monitoring may show a decrease in activity, loss of heart rate variability, and heart rate decelerations. If placental respiratory failure persists, the fetus will make a series of gasps followed by apnea and bradycardia. If the fetus is born in the early phase of respiratory failure, tactile stimulation may be sufficient to initiate spontaneous breathing and recovery. If the fetus is born in a later phase of respiratory failure, stimulation will not be sufficient and the newborn will require assisted ventilation for recovery.