Antenatal Counseling
- Check material and role assignment.
- Anticipate possible complications.
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BIRTH (CLOCK)
Term pregnancy?
Is he breathing or crying?
Good muscle tone?
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Routine Care: Mother Skin to Skin
- Delay cord clamping: Beneficial for the transition.
- Provide heat: Skin-to-skin contact with the mother, cover with a dry, warm towel.
- Ensure open airway: Position and clean if necessary.
- Continuous evaluation: Monitor color, breathing and tone.
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Initial Stabilization Steps (First 60s)
- Consider delayed cord clamping: If the condition of the newborn allows it.
- Place under heat source: Radiant crib.
- Head position, open airway: Slight extension of the neck ("sniffing position").
- Dry, stimulate: Rub back and soles of feet.
- Reposition head.
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Evaluate Heart Rate (HR) and Respiration
HR < 100 bpm, "gasping" or apnea?
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Care and Observation: Mother Skin to Skin
- Provide heat: Skin-to-skin contact with the mother, cover with a dry, warm towel.
- Ensure open airway: Position and clean if necessary.
- Continuous evaluation: Monitor color, breathing and tone.
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Persistent Respiratory Difficulty
- Rate CPAP: Continuous positive airway pressure (5-6 cmH₂O).
- SpO₂ monitoring: Place pulse oximeter on RIGHT hand or wrist (preductal).
- Initial [O₂] 21% (ambient air): Modify according to pulse oximetry to achieve objectives.
Preductal SpO₂ Targets
| Time | SpO₂ |
|---|---|
| 3 min | 70-80% |
| 5 min | 80-90% |
| 10 min | 90-95% |
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VENTILATE (VPP)
Start positive pressure ventilation (PPV) at a rate of 40-60 rpm.
- SpO₂ monitoring: Place a preductal pulse oximeter.
- ECG if available: For accurate and continuous HR monitoring.
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Reevaluate FC
Does HR < 100 bpm persist?
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Assess Breathing
What is spontaneous breathing like?
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Ensure / Correct Ventilation Maneuvers
Perform corrective ventilation steps (MR. SOPA):
- M: Mask, readjust.
- R: Reposition airway.
- S: Suck mouth and nose.
- O: Open mouth.
- P: Pressure, increase.
- A: Alternative airway (intubation).
Consider endotracheal intubation if PPV with a mask is not effective.
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Reevaluate FC
HR < 60 bpm?
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Chest Compressions
Initiate chest compressions coordinated with PPV in a 3:1 ratio (90 compressions and 30 ventilations per minute).
- Endotracheal intubation: If it has not been done, it is a priority.
- [O₂] 100%: Increase FiO₂ to 100%.
- ECG monitoring: Essential for accurate assessment of HR.
- Umbilical vein cannulation: For emergency vascular access.
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Reevaluate FC
HR < 60 bpm?
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Adrenaline and Volume
- Adrenalin: Administer intravenously (umbilical) or endotracheally.
- IV: 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution).
- ET: 0.05-0.1 mg/kg (0.5-1 mL/kg of 1:10,000 solution).
- Repeat every 3-5 minutes if HR persists < 60 bpm.
- Consider volume expansion: If hypovolemia is suspected (paleness, weak pulses, history of blood loss). Administer Physiological Saline or Blood O- 10 mL/kg.