RESUSCITATION OF THE NEONATE AFTER C - SECTION ERIN SPENCER, M.ED., CVT, VTS ( ECC )
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opioid. If other conditions present themselves naloxone should not be used until other e ff orts have been made to correct these conditions. • Overall, normalizing body temperature will help with both respiration and heart rate. Drying the neonate and keeping them in a warm environment will aid in normalizing and maintaining body temperature. 2 Once the neonate has been successfully resuscitated, the umbilical cord should be tied o ff . Suture material can be used to tie a strong knot around the umbilical cord. An indent should be seen in the cord to ensure that it is tight enough to occlude the vessel. The knot should be close to the abdomen. Once the knot is secure, the portion of the umbilical cord distal to the knot should be cut with a sterile blade or scissors.
fluid and mucus without causing trauma. Surgical suction units should be avoided. • Vigorous rubbing should be used to stimulate the neonate. Swinging puppies and kittens in a downward motion should be avoided as this method has been shown to cause injury and also increases the risk of dropping. • Oxygen should be administered via face mask until the neonate is breathing regularly on its own with a sustained respiratory rate of at least 30 breaths/minute. Chest muscle weakness or overall depression may be seen due to the drugs used for the dam/ queen’s anesthesia. If delivery via face mask is not possible, the neonate can be intubated with a red rubber catheter or a stylet- less IV catheter. These tubes can be removed once the previously stated parameters are met. • The nasal philtrum acupuncture point can be used to stimulate breathing in apneic neonates. A 25g needle can be inserted into the philtrum and then rotated. • Doxapram has been found to have little e ff ect in the face of hypoxia. Given that the neonate is born in a state of hypoxia, doxapram is no longer indicated for stimulation of breathing in the neonate. The only time it may be indicated is in apneic neonates who have not responded to other means of resuscitation.
The “B” stands for body temperature . • Normal body temperature of neonates is between 95°-99°. • Warm towels should be used to rub the neonates. Rubbing will help to dry and also stimulate the neonates. • Newborn puppies and kittens are unable to regulate their body temperature so it is important to provide a heat source. The important factors to remember are that inability to regulate means that neonates can overheat as well so the source of heat should not come in direct contact with the neonate and needs to be continually monitored to ensure overheating and/or burns do not occur. The “C” stands for circulation . • In most instances, if a normal respiratory rate can be reached, then the heart rate will increase. Bradycardia can be due to hypoxia so increasing respiratory rate and oxygen saturation will likely increase heart rate. Keeping neonates warm will also increase peripheral circulation. naloxone can be given sublingually or IM (0.1 mg/kg). It should be noted that naloxone may worsen existing bradycardia in a hypoxemic patient so this drug should only be used in cases where the goal is to reverse the depression e ff ects of an • For neonates that are slow to respond to resuscitation e ff orts
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