neonatalResuscitation

neonatalResuscitation - PresentedMay2003...

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Resuscitation Of Newborn Darko J. Vodopich MD Anesthesia Resident @ CWRU - MHMC Presented May 2003 Revised by: Greg Gordon MD
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Perinatal stress  Cathecolamines (CCA) are good - if neonate is  deprived CCA less survival rate  CCA maintain CO  CCA redistribute blood flow towards important  areas   BP and  HR     MVO 2  Neonates with   CCA have higher Apgar scores  CCA are important in a transition to extrauterine  life 
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Perinatal Cardiorespiratory physiology   Fetal lungs  24 days -arises from the foregut  26-28 weeks -terminal airways developed  30-32 weeks -final surface active material (SAM)  developed   Plasma ultrafiltrate  is a normal part of the lungs  Every day IU (intrauterine) 50-150 ml/kg/day of  plasma is produced  Plasma is swallowed in the gut and excreted by  kidneys
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Perinatal Cardiorespiratory physiology   Plasma ultrafiltrate (2)  2/3 is expelled during vaginal delivery  1/3 is removed capillaries, lymphatics, breathing  If fluid is retained into lungs causes  TTN   (transient  tachypnea of newborn)  Causes:   Small infants  Preterm infants  Rapidly born  Cesarean section born babies
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Perinatal Cardiorespiratory physiology  Normal breathing - 30/min @ 90 sec of age Stimulate Depress Mild acidosis Severe acidosis Hypercarbia CNS damage Hypoxia Pain Drugs Cold Magnesium Touch Alcohol Noise Opiods Umbilical cord clamping Barbiturates
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Perinatal Cardiorespiratory physiology  Normal breathing - 30/min @ 90 sec of age  (reminder)  Normal breathing - 40-60/min @ few minutes of age:  Removal of increased CO2 produced by high metabolic rate  Helps maintain FRC
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Perinatal Cardiorespiratory physiology Circulation of the fetus:  RV ~ 2/3 of CO  LV ~ 1/3 CO  Foramen ovale  Ductus arteriosus  Blood is coming from placenta - high O content  95% of the blood coming from placenta goes to LA  through foramen ovale
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Circulation of the fetus: The numbers are combined ventricular output
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Perinatal Cardiorespiratory physiology Circulation of the newborn:  PVR is   due to pulmonary expansion, breathing,    pH, and   O 2  tension   If neonate is born by CS -    PAP’s and PVR  PVR is  :  Hypoxia  Acidosis  Hypovolemia  Hypoventilation  Atelectasis  Cold
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Perinatal Cardiorespiratory physiology Changes in circulation of the newborn:    PVR -   pulmonary blood flow  Right/left shunting will be decreased  LA pressures are  , and seal foramen ovale  Ductus arteriosus closes (10-14 days) in response to   O2  Ach
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neonatalResuscitation - PresentedMay2003...

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