Topics Discussed: bag valve mask ventilation; birth weight; critical care; heart massage; newborn resuscitation.
Excerpt:"About 10% of all newborns require some assistance to begin breathing after birth, and ~1% require extensive resuscitation efforts. Newborn resuscitation cannot always be anticipated in time to transfer the mother before delivery to a facility with specialized neonatal support. Therefore, every hospital with a delivery suite should have an organized, skilled resuscitation team and appropriate equipment available (Table 31).Normal physiologic events at birth. Normal transitional events at birth begin with initial lung expansion, generally requiring large negative intrathoracic pressures, followed by a cry (expiration against a partially closed glottis). Umbilical cord clamping is accompanied by a rise in systemic blood pressure and massive stimulation of the sympathetic nervous system. With onset of respiration and lung expansion, pulmonary vascular resistance decreases, followed by a gradual transition (over minutes to hours) from fetal to adult circulation, with closure of the foramen ovale and ductus arteriosus.
Abnormal physiologic events at birth. The asphyxiated newborn undergoes an abnormal transition. Acutely with asphyxiation the fetus develops primary apnea, during which spontaneous respirations can be induced by appropriate sensory stimuli. If the asphyxial insult persists about another minute, the fetus develops deep gasping for 45 minutes, followed by a period of secondary apnea, during which spontaneous respirations cannot be induced by sensory..."
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