chunk_id stringlengths 16 16 | text stringlengths 29 2.42k |
|---|---|
bc7298c11d0eb085 | ## Background
used to inform the birthing person about birth choices that are safe, possible, and evidencebased. The purpose of this article is to discuss the role of birth plans, detail their components, and review perinatal outcomes, patient satisfaction, provider best perspectives, and practices regarding birth pla... |
1b3f9da06a138d2b | #### Methods
A literature search was undertaken by a university librarian using the search engines PubMed and CINAHL. The
Expert Review ajog.org
searches were limited to English only and extended from database inception through July 31, 2022. A search was undertaken with the term "birth plans" encompassing various ... |
ab16071caf39ef65 | ## Birth plan components
The discussion about the birth plan should occur between the birthing person (and their support persons if desired) and their provider early enough in the prenatal course so that options are thoroughly clarified before birth. This conversation is a good opportunity to discuss birth preferences... |
57c5e690e7db87c9 | ## Birth plan components
The Journal of Midwifery & Women's Health published a simple template that can be used to help define birth preferences. If no template is used or desired, the birthing person can be asked to simply write their desires and preferences for their birth. Their partner should be included in the bi... |
c198f90455db51f0 | ## Birth plan components
The Table illustrates sample items and categories that could be considered for a birth plan. The broad categories that may be discussed include birth location, support persons, birth attenbirth environment, labor preferences, labor course, fetal wellbeing assessment, pain relief, delivery, ces... |
d9fcb5e68ac7ead2 | ### Birth plans and patient satisfaction
Several studies and reviews have examined patient satisfaction regarding birth plans, and the results are somewhat mixed. Most studies show overall higher satisfaction rates among patients who use a birth plan compared with those who do not.9 A systematic review demonstrated hi... |
2604303a089944e5 | ### Birth plans and patient satisfaction
escribed the birth plan as simply a helpful introduction to the aspects of the birthing experience. 11 Patients commented that the process of creating a birth plan was very educational in regard to their options and hospital policy, and provided an opportunity to address concer... |
1bc23a60e959e564 | ### Birth plans and patient satisfaction
Another overarching theme is that pregnant people with birth plans are more satisfied with the birth experience because of an increased sense of autonomy. Patient autonomy is cited as being one of the most influential factors of patient satisfaction after giving birth. Patients... |
9b8974b7d2cc6ed7 | ### Birth plans and patient satisfaction
ociated with higher satisfaction (P=.03) and the patient having a greater sense of control (P>.01). A systematic review showed that there was a higher rate of satisfaction among patients whose premeditated birth plans were followed. Another review on birth expectations and post... |
62f74cf0031604eb | ### Birth plans and patient satisfaction
n whose birth plans and expectations were met, 98.7% reported satisfaction with their care overall. 19 For women who seek information about birth from sources outside of the medical profession, the degree of satisfaction is again related to how many of their expectations were a... |
b8b33940fe0376ab | ### Birth plans and patient satisfaction
However, another study showed that having a higher number of requests on the birth plan was associated with an 80% reduction in satisfaction (P < .01). 17 When unexpected medical complications arise, which may cause more interventions, one survey showed that pregnant people had... |
6f25e3b4f4318169 | ### Birth plans and patient satisfaction
.01) and felt less in control (P < .01) of their birth experience than those without a birth plan. 20 In a study of over 1000 patients, there was no considerable difference in birth satisfaction scores between women with and
**Expert Review** ajog.org
those without a birth pl... |
ce5491769f8280b0 | # Sample birth plan outline
Demographics:
Name
Due date
Patient contact information Health factors OB provider |
f56f21664e311fe9 | #### Birth location
- Home birth
- Out-of-hospital birth center
- Hospital birth center
- Hospital L&D unit |
d160f3dc34a0fcea | #### Birth environment
- Lighting
- Music
- Aromatherapy
- Clothing (hospital, personal, none)
- Space for support person(s) (couch, chair, bed, etc.)
- Photos and/or videos |
10ad9fa7879b1f3c | #### Fetal well-being assessment
- Intermittent auscultation
- Intermittent electronic fetal monitoring
- Continuous electronic fetal monitoring
- Wired vs wireless electronic continuous fetal monitoring
- External vs internal monitoring for fetal heart rate and/or uterine activity |
15c1d92a7c5e2219 | ## Support persons
- Partner(s) or significant other(s)
- Family
- Children
- Doula |
5337f5ae8e1af258 | ## Pain relief
- **Unmedicated**
- Nitrous oxide
- IV medication
- Hypnosis
- **Breathing techniques**
- Meditation
- **Acupressure**
- Acupuncture
- Reflexology
- Massage
- Pudendal, local, cervical block
- Transcutaneous electrical nerve stimulation (TENS)
- Cannabis products
- Open to options while in labor
- Hydro... |
55d5846ecf71774b | ## Birth attendants
- Physician, midwife (CNM, CM, CPM, lay midwife)
- Nursing staff
- Students (nursing, midwifery, medical students, and others)
- No medical attendant (freebirth)
- Religious or cultural preferences |
31b677162409c92c | # Labor management
- Spontaneous labor
- Induction of labor (elective vs medically indicated) and methods for induction
- Rupture of membranes
- Augmentation |
61d9debf23457970 | ## Delivery
- Position
- Involvement and location of support person(s) during
- Support person to help catch newborn
- Mirror
- Natural tearing
- **Episiotomy**
- Delayed cord clamping
- Who will cut the cord
- Placenta delivery
- Placenta disposal by facility or woman to take home
- Use of vacuum or forceps in deli... |
ec1a75138e91e5e5 | ## Cesarean delivery
- Support person(s)
- Clear or solid drape
- Dropping drape
- Skin-to-skin contact and breastfeeding in OR
- Anesthesia options
- Arm free |
89362e3253abd440 | #### Newborn/postpartum
- If sex is unknown, desires regarding sex announcement
- Skin-to-skin contact or dry infant first
- No separation of mother and infant "golden hour"
- Immediate breastfeeding or delayed
- Timing/routine procedures
- Vaccines, vitamin K, eye ointment
- Rooming-in
- Nursery
- Circumcision
- Paci... |
9bb8fadbed223a11 | # Birth plans and perinatal outcomes
For intrapartum outcomes specifically, one study showed that women with a birth plan were less likely to use epidural analgesia compared with women without a birth plan (69.7% vs 80.3%; P=.009). Those women were also less likely to have early amniotomy (34.3% vs 55.6%; P=.001) and ... |
158963086db3ec9d | # Birth plans and perinatal outcomes
plan were 28% less likely to have oxytocin (P<.01), 29% less likely to have amniotomy (P < .01), and 31% less likely to have a neuraxial anesthesia (P < .01). There was no difference in the time in labor (P=.12). For cesarean deliveries, the data are mostly positive for patients wi... |
17344908b5d3e9e9 | # Birth plans and perinatal outcomes
abor (P=.12). For cesarean deliveries, the data are mostly positive for patients with a birth plan. According to a previously mentioned study, primiparous women with a birth plan were less likely to have a cesarean delivery (18% vs 29%; P=.027), with no difference in the rates of o... |
d46213c214eaa6c1 | # Birth plans and perinatal outcomes
. In contrast, a smaller study of 300 women showed that having a birth plan was not associated with a statistically significant difference in the rate of cesarean delivery (21% with birth plan vs 16% without; adjusted odds ratio, 1.11; 95% confidence interval, 0.61-2.04). 20,24 Ove... |
497a37c838d119cf | # Birth plans and perinatal outcomes
An integrative review of 13 studies identified several themes: the birth plan positively influences labor and delivery and maternal—fetal outcomes, especially in primiparous women; maternal expectations, when unmet, can cause dissatisfaction; and providers play a key role in suppor... |
752777a9d75d9d3a | # Provider perspectives
There are documented maternal and neonatal benefits to having a birth plan, but the provider's perspective on the matter may sometimes be at odds with those benefits. |
72ebbc0812297169 | # Provider perspectives
th plan, but the provider's perspective on the matter may sometimes be at odds with those benefits. In one study of a cohort of 77% physicians and 22% midwives from 2015 to 2016, most (66.5%) did not recommend birth plans, and nearly onethird of the providers thought birth plans were predictive... |
7df18a4a181fa8f2 | # Provider perspectives
attempt by the birthing person to control a process that, by nature, cannot be controlled; 13% also labeled the birth plans as problematic because of their restrictive and overly detailed nature. Moreover, 6% of providers agreed that a birth plan could be associated with increased maternal anxi... |
0e69df481bb3cc15 | # Provider perspectives
care. 12 Only 5% of the providers in this study did not identify any disadvantages to a birth plan. 12 In contrast, 41% of the providers agreed that a birth plan is useful for education about the birth process, and 20% noted that it promotes shared decisionmaking. Almost an equal percentage of ... |
c81fd7f92870ad11 | # Provider perspectives
the birth plan with the patient in the outpatient setting and the on-call physician at the time of delivery. As mentioned before, some providers may feel a loss of professional autonomy or perhaps a heightened sense of medical liability related to adherence to the birth plan. |
3daf90935a680f70 | #### Conclusion
The goal of a birth plan is for the patient to express their desires and preferences for labor and birth. Evidence is conflicting regarding the benefits and risks of birth plans, and studies on birth plans and their outcomes are limited by lack of diverse demographic data and thus generalizability. 10,... |
59b3ee1287c0437f | #### Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term... |
c1486601e03da6b8 | #### Abstract
lt;sup>a Department of Neonatology, University Hospitals Plymouth, Plymouth, UK
lt;sup>b Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
lt;sup>c Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, UK
d Nuffield Department of Populatio... |
550974c625f9dc5a | #### Abstract
lt;sup>h University of Melbourne, Australia
lt;sup>1 Department of Obstetrics, University of Cambridge, UK
lt;sup>1 Department for Neonatology and Pediatric Intensive Care Medicine, Clinic for Pediatrics, University Hospital C.G.Carus, Technische Universität Dresden, Germany
lt;sup>k Center for Feto-N... |
dd596402f8b4515c | ## Introduction and scope
These guidelines are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support.1 For the purposes of the ERC Guidelines the ILCOR recommendations were supplemented by focused literature revie... |
0390478b476d6711 | #### Summary of changes since the 2015 guidelines Management of the umbilical cord
Clamping after at least 60 s is recommended, ideally after the lungs are aerated. Where delayed cord clamping is not possible cord milking should be considered in infants >28 weeks gestation. |
c8d3777b7f770c06 | #### Infants born through meconium-stained liquor
In non-vigorous infants, recommendations are against immediate laryngoscopy with or without suction after delivery, because this may delay aeration and ventilation of the lungs. |
45c8692e2f3f26d0 | #### Use of the laryngeal mask
If facemask ventilation is unsuccessful or if tracheal intubation is unsuccessful or not feasible a laryngeal mask may be considered as an alternative means of establishing an airway in infants of >34 weeks gestation (about 2000 g, although some devices have been used successfully in inf... |
8983a69e25d9c0b7 | #### Inflation pressure
If there is no response to initial inflations despite an open airway then a gradual increase in the inflation pressure is suggested.
A starting pressure of 25 cm H2O is suggested for preterm infants <32 weeks gestation. |
97b44f0a24a933fc | #### Air/oxygen for preterm resuscitation
Recommendations are for starting in air at 32 weeks gestation or more, 21- 30% inspired oxygen at 28-31 weeks gestation and 30% inspired oxygen at <28 weeks gestation.
The concentration should be titrated to achieve saturations of 80% at 5 min of age because there is evidence... |
ef65fd599688cdfc | #### Chest compressions
If chest compressions are required, the inspired oxygen concentration should be increased to 100% and consideration given towards securing the airway ideally with a tracheal tube. |
63c773e19978fcf2 | #### Vascular access
The umbilical vein is still favoured as the optimal route of access but, intraosseous access is an alternative method of emergency access for drugs/fluids. |
96734db737b99ecf | #### Adrenaline
Where the heart rate has not increased after optimising ventilation and chest compressions an intravenous dose of adrenaline of 30 micrograms kg is recommended, repeated every 35 min in the absence of a response. |
dbec3c1644c09512 | #### Glucose during resuscitation
An intravenous dose of 250 mg kg (2.5 mL kg of 10% glucose) is suggested in a prolonged resuscitation to reduce the likelihood of hypoglycaemia. |
0abfc623e79157cb | #### Prognosis
Failure to respond despite 1020 mins of intensive resuscitation is associated with high risk of poor outcome. It is appropriate to consider discussions with the team and family about withdrawal of treatment if there has been no response despite the provision of all recommended steps of resuscitation and... |
7b92000149e367d7 | ## Transition and the need for assistance after birth
Most, but not all, infants adapt well to extra-uterine life but some require help with stabilisation, or resuscitation. Up to 85% breathe spontaneously without intervention; a further 10% respond after drying, stimulation and airway opening manoeuvres; approximatel... |
45aea6f57c7dfa26 | ## Risk factors
A number of risk factors have been identified as increasing the likelihood of requiring help with stabilisation, or resuscitation (Fig. 1). |
e6d7a74b018d0ee5 | #### Staff attending delivery
Any infant may develop problems during birth. Local guidelines indicating who should attend deliveries should be developed, based on current understanding of best practice and clinical audit, and taking into account identified risk factors (Fig. 1). As a guide,
- Personnel competent in n... |
4f0493e0320b73ad | #### Equipment and environment
- All equipment must be regularly checked and ready for use.
- Where possible, the environment and equipment should be prepared in advance of the delivery of the infant. Checklists facilitate these tasks.
- Resuscitation should take place in a warm, well-illuminated, draught-free area wi... |
b6f6511d3eaa6da3 | #### Planned home deliveries
- Ideally, two trained professionals should be present at all home deliveries.
- At least one must be competent in providing mask ventilation and chest compressions to the newborn infant.
- Recommendations as to who should attend a planned home delivery vary from country to country, but th... |
9a2f96bfd277020e | #### Planned home deliveries
- When a birth takes place in a non-designated delivery area a minimum set of equipment of an appropriate size for the newborn infant should be available, including:
- clean gloves for the attendant and assistants,
- means of keeping the infant warm, such as heated dry towels and blanket... |
de5a9bf19b2b4a7d | #### Planned home deliveries
- Caregivers undertaking home deliveries should have pre-defined plans for difficult situations. |
5cc7abfa29235feb | ### Briefing
- If there is sufficient time, brief the team to clarify responsibilities, check equipment and plan the stabilisation, or resuscitation.
- Roles and tasks should be assignedchecklists are helpful.
- Prepare the family if it is anticipated that resuscitation might be required. |
0939407d9607fe45 | ## Recommendations
- Newborn resuscitation providers must have relevant current knowledge, technical and non-technical skills.
- Institutions or clinical areas where deliveries may occur should have structured educational programmes, teaching the knowledge and skills required for newborn resuscitation.
- The content a... |
edea1a2f5507525f | ## Standards
- The infant's temperature should be regularly monitored after birth and the admission temperature should be recorded as a prognostic and quality indicator.
- The temperature of newborn infants should be maintained between 36.5 C and 37.5 C.
- Hypothermia (36.0 C) and hyperthermia (>38.0 C) should be avoi... |
c871a339e8095f23 | ## Environment
- Protect the infant from draughts. Ensure windows are closed and air-conditioning appropriately programmed.
- Keep the environment in which the infant is looked after (e.g. delivery room or theatre) warm at 2325 C.
- For infants 28 weeks gestation the delivery room or theatre temperature should be >25 ... |
fdaa71004ee8c7bb | #### Term and near-term infants >32 weeks gestation
- Dry the infant immediately after delivery. Cover the head and body of the infant, apart from the face, with a warm and dry towel to prevent further heat loss.
- If no resuscitation is required place the infant skin-to-skin with mother and cover both with a towel. O... |
214f7f40b33fcf0c | #### Out of hospital management
- Infants born unexpectedly outside a normal delivery environment are at higher risk of hypothermia and subsequent poorer outcomes.
- They may benefit from placement in a food grade plastic bag after drying and then swaddling. Alternatively, well newborns >30 weeks gestation may be drie... |
caf85dabd375ba9a | #### Management of the umbilical cord after birth
- The options for managing cord clamping and the rationale should be discussed with parents before birth.
- Where immediate resuscitation or stabilisation is not required, aim to delay clamping the cord for at least 60 s. A longer period may be more beneficial
- Clampi... |
4228e60ab3d9ffa2 | #### Initial assessment (Fig. 3)
Fig. 3 – Assessment of tone, breathing and heart rate help determine the need for intervention.
May occur before the umbilical cord is clamped and cut (typically performed in this order):
- Observe Tone (& Colour)
- Assess adequacy of Breathing
- Assess the Heart Rate
- Take appropri... |
41b975428f3d9c56 | #### **Tactile stimulation**
Initial handling is an opportunity to stimulate the infant during assessment by
- Drying the infant.
- Gently stimulating as you dry them, for example by rubbing the soles of the feet or the back of the chest. Avoid more aggressive methods of stimulation. |
58a9ac909fcbb73a | #### Tone and colour
- A very floppy infant is likely to need ventilatory support.
- Colour is a poor means of judging oxygenation. Cyanosis can be difficult to recognise. Pallor might indicate shock or rarely hypovolaemia
consider blood loss and plan appropriate intervention. |
2c9bba967851542e | ## Breathing
- Is the infant breathing?
Note the rate, depth and symmetry, work/effort of breathing as
- Adequate
- Inadequate/abnormal pattern such as gasping or grunting
- Absent |
37c446e1dc2992ac | #### Heart rate
- Determine the heart rate with a stethoscope and a saturation monitor ± ECG (electrocardiogram) for later continuous assessment
- Fast (≥100 min) satisfactory
- Slow (60-100 min) intermediate, possible hypoxia
- Very slow/absent (<60 min) critical, hypoxia likely
If the infant fails to establish s... |
39a16f9b18c9c8e3 | ### Classification according to initial assessment
On the basis of the initial assessment, the infant can usually be placed into one of three groups as the following examples illustrate.
1.
Fig. 4a - Satisfactory transition. |
6349626144d4eb8f | #### Good tone
Vigorous breathing or crying
Heart rate - fast (≥100 min)
Assessment: Satisfactory transition – Breathing does not require support. Heart rate is acceptable (Fig. 4a). |
bfde546efd7ff0a5 | #### Actions:
- Delay cord clamping.
- Dry, wrap in warm towel.
- Keep with mother or carer and ensure maintenance of temperature.
- Consider early skin-to-skin care if stable.
2.
Fig. 4b - Incomplete transition. |
7366b802a75c708d | #### Reduced tone
Breathing inadequately (or apnoeic)
Heart rate - slow ( $<100 \,\mathrm{min}^{-1}$ )
Assessment: *Incomplete transition* – Breathing requires support, slow heart rate may indicate hypoxia (Fig. 4b). |
1e953f5ca70adcc1 | #### Actions:
Delay cord clamping only if you are able to appropriately support the infant.
- Dry, stimulate, wrap in a warm towel.
- Maintain the airway, lung inflation and ventilation.
- Continuously assess changes in heart rate and breathing
- If no improvement in heart rate, continue with ventilation.
- Help may ... |
d0bee1f8e333385f | #### Actions:
- Clamp cord immediately and transfer to the resuscitation platform.
Delay cord clamping only if you are able to appropriately support/resuscitate the infant.
- Dry, stimulate, wrap in warm towel.
- Maintain the airway lung inflation and ventilation.
- Continuously assess heart rate, breathing, and effe... |
89ebf3f5fb5612e2 | #### Preterm infants
- Same principles apply.
- Consider alternative/additional methods for thermal care e.g. polyethylene wrap.
- Gently support, initially with CPAP if breathing.
- Consider continuous rather than intermittent monitoring (pulse oximetry ± ECG) |
6b66ad294786d433 | #### Newborn life support
Following initial assessment and intervention, continue respiratory support if:
- The infant has not established adequate, regular breathing, or
- The heart rate is <100 min.
Ensuring an open airway, aerating and ventilating the lungs is usually all that is necessary. Without these, other i... |
ea22325895f982fa | #### **Airway**
Commence life support if initial assessment shows that the infant has not established adequate regular normal breathing, or has a heart rate <100 min (Fig. 5).
Establishing and maintaining an open airway is essential to achieve postnatal transition and spontaneous breathing, or for further resuscitati... |
36408605a2d579f2 | #### Techniques to help open the airway
Place the infant on their back with the head supported in a neutral position (Fig. 6a).
Fig. 6a – Head in a neutral position. Face is horizontal (middle picture), neither flexed (left) or extended (right).
In floppy infants, pulling the jaw forwards (jaw lift) may be essentia... |
b9c2a742b3551719 | ## Airway obstruction
- Airway obstruction can be due to inappropriate positioning, decreased airway tone and/or laryngeal adduction, especially in preterm infants at birth.
- Suction is only required if airway obstruction due to mucus, vernix, meconium, blood clots, etc. is confirmed through inspection of the pharynx... |
547a3b48629910be | ## Meconium
- Non-vigorous newborn infants delivered through meconiumstained amniotic fluid are at significant risk for requiring advanced resuscitation and a neonatal team competent in advanced resuscitation may be required.
- Routine suctioning of the airway of non-vigorous infants is likely to delay initiating vent... |
f714c241642cbb76 | #### Lung inflation (Fig. 7)
- If apnoeic, gasping or not breathing effectively, aim to start positive pressure ventilation as soon as possible ideally within 60 s of birth.
- Apply an appropriately fitting facemask connected to a means of providing positive pressure ventilation, ensuring a good seal between mask and ... |
70d4538e6e4aa65e | ### Assessment
- Check the heart rate
- An increase (within 30 s) in heart rate, or a stable heart rate if initially high, confirms adequate ventilation/oxygenation.
- A slow or very slow heart rate usually suggests continued hypoxia and almost always indicates inadequate ventilation.
- Check for chest movement
- Vi... |
c8829bab32f85407 | #### Ventilation \(Fig. 8)
If there is a heart rate response
- Continue uninterrupted ventilation until the infant begins to breathe adequately and the heart rate is above 100 min .
- Aim for about 30 breaths min with an inflation time of under 1 s.
- Reduce the inflation pressure if the chest is moving well.
- Reass... |
56eb9eca1c18d5d6 | #### Failure to respond
If there is no heart rate response and the chest is not moving with inflations
- Check if the equipment is working properly.
- Recheck the head-position and jaw lift/thrust
- Recheck mask size, position and seal.
- Consider other airway manoeuvres:
- 2-person mask support if single handed ini... |
82b8578994b1a41f | ## Then:
- Repeat inflations.
- Continuously assess heart rate and chest movement.
If the insertion of a laryngeal mask or tracheal intubation is considered, it must be undertaken by personnel competent in the procedure with appropriate equipment. Otherwise continue with mask ventilation and call for help.
Without a... |
6617b176fa613d9e | ## Continuous positive airway pressure (CPAP) and positive end expiratory pressure (PEEP)
- In spontaneously breathing preterm infants consider CPAP as the initial method of breathing support after delivery using either mask or nasal prongs.
- If equipment permits, apply PEEP at minimum of 56 cm H2O when providing pos... |
b7bc35a8051efae5 | #### Assisted ventilation devices
Ensure a facemask of appropriate size is used to provide a good seal between mask and face.
- Where possible use a T-piece resuscitator (TPR) capable of providing either CPAP or PPV with PEEP when providing ventilatory support, especially in the preterm infant.
- Nasal prongs of appr... |
69dcb40e8b8a886e | ## Laryngeal mask
- Consider using a laryngeal mask
- In infants of34 weeks gestation (about 2000 g) although some devices have been used successfully in infants down to 1500 g.
- If there are problems with establishing effective ventilation with a facemask.
- Where intubation is not possible or deemed unsafe becau... |
a547867ae1f9e4d3 | ## Tracheal tube
- Tracheal intubation may be considered at several points during neonatal resuscitation:
- When ventilation is ineffective after correction of mask technique and/or the infant's head position, and/or increasing inspiratory pressure with TPR or bag-mask.
- Where ventilation is prolonged, to enable a ... |
ad5a7dc5c79595d7 | #### Table 1 – Approximate oral tracheal tube size by gestation (for approximate nasotracheal tube length add 1 cm).
| Gestational age (weeks) | Length at lips (cm) | Internal diameter (mm) |
|----------------------------|------------------------|---------------------------|
| 2324 | 5.5 | 2.5 |
| 2526 | 6.0 | 2.5 |
|... |
444f990435bb6481 | ## Term and late preterm infants 35 weeks
In infants receiving respiratory support at birth, begin with air (21%). |
4df350d080e77465 | ## Preterm infants <35 weeks
Resuscitation should be initiated in air or a low inspired oxygen concentration based on gestational age:
32 weeks 21% 2831 weeks 2130% <28 weeks 30%
In infants <32 weeks gestation the target should be to avoid an oxygen saturation below 80% and/or bradycardia at 5 min of age. Both are... |
12303463baeb1415 | #### Assessment of the need for chest compressions (Fig. 9)
- If the heart rate remains very slow (<60 min ) or absent after 30 s of good quality ventilation, start chest compressions.
- When starting compressions:
- Increase the delivered inspired oxygen to 100%.
- Call for experienced help if not already summoned.... |
956db898959b78b5 | #### Delivery of chest compressions
- Use a synchronous technique, providing three compressions to one ventilation at about 15 cycles every 30 s.
- Use a two-handed technique for compressions if possible.
- Re-evaluate the response every 30 s.
- If the heart rate remains very slow or absent, continue ventilation and c... |
6c63c6c5c1a80886 | #### Consider
Vascular access and drugs. |
4b3d10f99a74d7b0 | #### Umbilical venous access
- The umbilical vein offers rapid vascular access in newborn infants and should be considered the primary method during resuscitation.
- Ensure a closed system to prevent air embolism during insertion should the infant gasp and generate sufficient negative pressure.
- Confirm position in a... |
133ac6847588f4d9 | #### Support of transition/post-resuscitation care
- If venous access is required following resuscitation, peripheral access may be adequate unless multiple infusions are required in which case central access may be preferred.
- IO access may be sufficient in the short term if no other site is available. |
04164a31dadd2a7c | ## During active resuscitation
Drugs are rarely required during newborn resuscitation and the evidence for the efficacy of any drug is limited. The following may be considered during resuscitation where, despite adequate control of the airway, effective ventilation and chest compressions for 30 s, there is an inadequa... |
157c749bd1131272 | ## Adrenaline
- When effective ventilation and chest compressions have failed to increase the heart rate above 60 min
- Intravenous or intraosseous is the preferred route:
- & At a dose of 1030 micrograms kg (0.10.3 mL kg of 1:10,000 adrenaline [1000 micrograms in 10 mL]).
- $\, \circ \,$ Intra-tracheally if intubat... |
a8be57faa37d815a | #### Glucose
- In a prolonged resuscitation to reduce likelihood of hypoglycaemia.
- Intravenous or intraosseous:
- 250 mg kg bolus (2.5 mL kg of 10% glucose solution). |
53e311c9fe5d0596 | #### Volume replacement
- With suspected blood loss or shock unresponsive to other resuscitative measures.
- Intravenous or intraosseous:
- 10 mL kg of group O Rh-negative blood or isotonic crystalloid. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.