Newsletter - traditional

Spring 2008 A Complimentary Publication
2005 Revised Neonatal
At birth a rapid assessment should be done to see if Resuscitation Guidelines the neonate is full term, is breathing, crying and has
good muscle tone and if the amniotic fluid is clear. Ventilation is required if the neonate is not breathing or breathing ineffectively. This is usually done with a bag/valve mask and 100% oxygen. After 30 seconds of ventilation the heart rate is checked. If it is less than 60, chest compressions should be started. Resuscitation is continued until the heart rate is consistently greater than 100. If the heart rate is not consistently over 60 within 30 seconds of starting responsibility is the infant. Some facilities or chest compressions, Epinephrine should be given providers have decided not to have NRP [neonatal down an endotracheal tube and IV fluids given resuscitation protocol] certified providers, but the through an umbilical vein catheter. The neonate is standard of care is the same and providers are still reassessed every 30 seconds for improving color, held to the NRP certification guidelines. spontaneous breathing and increasing muscle tone. Appropriate equipment and supplies also need to bereadily available and accessible. At a minimum this If you need assistance to evaluate a case involving includes oxygen, appropriately sized bag and mask neonatal resuscitation, give us a call. Source: American Academy of Pediatrics Neonatal Resuscitation Guidelines. Risk factors that put the mother or baby at risk for D e c i s i o n - T o - I n c i s i o n :
requiring resuscitation include [these are not all C h a l l e n g i n g T h e 3 0
M i n u t e R u l e
The National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network conducted a recent observational study to look at the outcomes from the time of a decision to perform a C-section to the time of incision.
polyhydramnios/oligohydramnios [too much or The data came from only primagravid women [first child] in active labor who had an infant that weighed over 2500 gm. Indications for c-sections included: nonreassuring fetal heart rate, umbilical cord prolapse, placental abruption, placenta previa with hemorrhage and uterine rupture. Over 11,000 cases maternal narcotics within 4 hrs of delivery The data clearly showed that more than one third of all c-sections for these indications did not comply Spring 2008
Improving Hospital Care for
• when the decision-to-incision time was less than Surgical Patients
30 minutes, the rates of fetal acidemia andintubation in the delivery room were higher In the last issue we discussed the “5 Million LivesCampaign”, that is aimed at reducing harm in US health • 95% of infants delivered in more than 31 minutes care facilities. One part of this initiative is improving did not experience any increase in the incidence hospital care for surgical patients. of hypoxic-ischemic encephalopathy, fetal deathor apgar scores <3 at 5 mins.
• only one in eight neonatal deaths occurred in the • preventing surgical site infections by appropriate use group of infants delivered after 31 mins. of prophylactic antibiotics and use of appropriate hair Source: OB Management: Vol.19, No 10. removal methods, glucose control in patients undergoing major cardiac surgery and maintaining normal FDA News. Haldol
body temperatures in patients undergoing colonsurgery.
• avoiding adverse cardiac events by continuing beta- blocker therapy for all patients taking a beta-blocker before admission for surgery and during theirhospitalization • preventing VTEs [venous thrombotic events, this includes both deep vein thrombosis and pulmonary associated with the administration of the embolism] through use of intermittent pneumatic antipsychotic medication, Haldol. This risk is compression devices and graduated compression administration or when given at doses higher than unfractionated heparin, low-molecular weight heparin or Coumadin. Short trips to the bathroom and walks upand down the halls are not enough to prevent VTE.
Injectable Haldol is approved by the FDA only for • preventing VAP [ventilator acquired pneumonia] by
intramuscular injection, although there is a lot of
elevating the head of bed to 30-45 degrees at alltimes except when care is being provided, allowing evidence in the medical literature that IV patients that are sedated to come up daily to assess administration is a common “off label” use for their responsiveness and readiness to wean, and severe agitation in the hospital setting. EKG administering daily medication to prevent peptic monitoring is recommended if Haldol is given intravenously. Source: www.medscape.com

Source: http://www.sharonscottrn.com/uploads/SAS_Neonatal_Res__c-section.pdf