NEONATAL CARDIOVASCULAR RESUSCITATION

neonatal cardiovascular resuscitation :
Cardiovascular support and chest compressions :
Most infants who present at delivery with a heart rate less than 100 BPM respond to effective ventilatory assistance with a rapid increase in heart rate to normal rates. In contrast, if an effective airway and effective ventilation is not established, further support is not effective. Chest compressions should be initiated following only 30 seconds of effective positive pressure ventilations if the heart rate remains less than 60 BPM.

An assessment of the heart rate can be obtained by palpating the umbilical stump at the level of insertion of the infant's abdomen or by direct auscultation of the precordium. Chest compressions should be discontinued as soon as the heart rate is higher than 60 BPM.

Chest compressions may be performed either by circling the chest with both hands and using a thumb to compress the sternum or by supporting the infant's back with one hand and using the tips of the middle and index finger to compress the sternum. The thumb technique is preferred because of improved depth control during compressions, however the 2-finger technique can be used.

Pressure should be applied to the lower portion of the sternum depressing it 0.5-0.75 inches at a rate of 90 per minute. One ventilation should be interposed after every 3 chest compressions allowing for 30 breaths per minute. The recommended ratio of chest compressions to ventilations is 3:1.

Evaluate the heart rate and color every 30 seconds. Infants who fail to respond may not be receiving effective ventilatory support, thus it is imperative to be evaluating the ventilation of the infant constantly.