Resuscitation of the Young Infant

Learning objectives

After completion of this session the participant should be able to:

Demonstrate the resuscitation of a sick young infant

This session covers resuscitation of a young infant (who may be just a few days old but who has not just been delivered). There are a lot of similarities with neonatal resuscitation and the skills required are similar.

The resuscitation of the YI is very similar to the newborn, except for the initial steps

First make sure baby is warm and blood sugar is normal

Temperature

All sick NYI are prone to hypothermia:
- Maintain thermal environment.
- Keep the infant dry and well wrapped.
- Hats help to reduce heat loss.
- Keep the room warm (at least 25ºC).
- Keep the baby under a radiant warmer.
Hypoglycaemia
- Check for blood glucose in all infants presenting with emergency signs, and all sick NYI.
- If you cannot measure blood glucose, give a bolus dose.
Managing Airway and Breathing

The letters A and B in “ABCCCD” represent “airway and breathing”.
To assess if the child has an airway or breathing problem you need to know:
Is the airway open?
Is the child breathing?
Is the child blue (centrally cyanosed)?
Does the child have severe respiratory distress?

A

The neck is slightly extended and the head is tilted by placing one hand onto the child’s forehead.
Lift the mandible up and outward by placing the fingertips of the other hand under the chin.

Conscious Unconscious

Inspect the mouth and remove secretions Open the airway with head tilt and chin lift

Let the infant assume a position of maximum comfor Inspect the mouth and remove secretions

Give oxygen Check if maneuver has improved air entry by looking at the chest

Continue assessment If not, insert airway

Conscious	Unconscious
Inspect the mouth and remove secretions	Open the airway with head tilt and chin lift
Let the infant assume a position of maximum comfor	Inspect the mouth and remove secretions
Give oxygen	Check if maneuver has improved air entry by looking at the chest
Continue assessment	If not, insert airway

Insertion of an oropharyngeal (Guedel) airway

The oropharyngeal or Guedel airway can be used in an unconscious infant to improve airway opening. It may not be tolerated in a patient who is awake and may induce choking or vomiting. Guedel airways come in different sizes; an appropriate sized airway goes from the angle of the mouth to the angle of the jaw when laid on the face with the convex side up.

Insert an oropharyngeal airway in an infant: convex side up

Select an appropriate sized airway
Position the child to open the airway
Insert the oropharyngeal airway the convex side up.
Re-check airway opening.
Use a different sized airway or reposition if necessary.

B

Does the child have Severe Respiratory Distress?

Is there difficulty in breathing while breastfeeding? Is the baby breathing very fast, has severe lower chest wall in-drawing, or using the accessory muscles for breathing which cause the head to nod with every inspiration? Are there any abnormal noises heard when breathing? A short noise when breathing out in young infants is called grunting. Grunting is a sign of severe respiratory distress.

Signs of severe respiratory distress

Grunting
Head nodding
Respiratory rate >80/min
Severe lower chest in-drawings
Apnoeic spells
Unable to feed due to respiratory distress
Cyanosis

Giving oxygen to a baby with respiratory distress

A baby with severe respiratory distress should be allowed to take a comfortable position of his choice and should be given oxygen. Oxygen may be provided with a catheter or prongs. If the baby’s breathing difficulty worsens or the baby has central cyanosis while on catheter or prongs: add oxygen at a high flow rate via a face mask (5 litres/min), if available.

Management of airway in a child with gasping or who has just stopped breathing

If the baby is not breathing, you need to manage the airway and support the breathing with a bag and mask.

Ventilate with bag and mask (BMV)

If the child is not breathing even after the above manoeuvers or spontaneous ventilation is inadequate (as judged by insufficient chest movements and inadequate breath sounds), ventilate with a self-inflating bag and mask.

During bag and mask ventilation it may be necessary to move the baby’s head and neck gently through a range of positions to determine the optimum position for airway patency and effectiveness of ventilation. A neutral position without hyperextension of the neck is usually appropriate for infants. Infants may need padding under the shoulder to prevent excessive flexion of the neck that occurs when their prominent occiput rests on the surface on which the child lies.

Bag and mask ventilation. Masks should be available in several sizes (size 0, 1)

Padding for an infant to maintain a patent airway

Call for help in any child who needs Bag and Mask Ventilation (BMV) since some of these infants may additionally need chest compression.

After five effective ventilations, check the pulse (femoral) for ten seconds. If pulse is absent, the second person should start chest compression.

C

Chest compressions (as in a neonate)

Note: while it is often possible to resuscitate a baby who has stopped breathing but still has a good heart beat i.e. a respiratory arrest, it is almost never possible to resuscitate a baby whose heart has stopped, i.e. a cardiorespiratory arrest.