Key points of neonatal laryngoscopic resuscitation

The health of children has always been the most concerned issue for our family members. When mothers are pregnant for ten months, it is a particularly happy thing. They all hope to give birth to a beautiful and healthy baby. The most painful thing is that the baby is unhealthy. Some children need rescue after birth. So, do you know about the situation of neonatal laryngoscopic resuscitation?

(1) It is important to fully understand the patient's medical history and be mentally and materially prepared for the resuscitation, such as personnel, oxygen, warming equipment, disposable straws, bag-mask resuscitators, neonatal laryngoscopes, batteries, small light bulbs, endotracheal tubes, connectors, stethoscopes, etc. First aid supplies should be fully stocked and positioned for immediate access, as time determines the success or failure of resuscitation. Respiratory arrest delayed resuscitation by 1 minute, gasping by about 2 minutes, and resumption of regular breathing by about 4 minutes.

(2) After the fetal head is delivered, one should not rush to deliver the shoulders. Instead, one should immediately squeeze out or use a vacuum bulb to suck out all the mucus in the mouth, throat, and nose. It is best to use a far-infrared radiation warming device afterwards, because newborns need a good warming environment when they are born. In an emergency, you can also use a large incandescent lamp to keep warm temporarily, but be careful not to get burned. Wiping off the amniotic fluid and blood on the body immediately after birth can reduce heat loss due to evaporation. Because the temperature regulation of asphyxiated children is unstable, once they are exposed to cold, their metabolism and oxygen consumption will increase to maintain body temperature, and metabolic acidosis will occur, which will be slow to correct after the body temperature drops. After the newborn is placed in a mild Trendelenburg position (≈15°), use a disposable straw to remove mucus from the mouth, pharynx, and nose. Each suction should not exceed 10 seconds. Stimulation of the vagus nerve deep in the oropharynx may cause bradycardia or apnea. If the amniotic fluid is contaminated with meconium, to prevent deep inhalation, the midwife can hold the baby's chest tightly with both hands, immediately use a laryngoscope to intubate the airway and suck out the water, and then use tactile stimulation to make the baby cry. Each endotracheal intubation and suction using a laryngoscope is required to be completed within 20 seconds. When using an electric suction pump, the negative pressure should be adjusted between 60 and 100 mmHg according to the viscosity of the mucus, and connected with a T-shaped finger hole or a flute-shaped straw to facilitate control during suction.

(3) After the evaluation, if the patient has spontaneous breathing, heart rate >100 beats/min, ruddy skin or cyanosis of the hands and feet, just continue to observe. In some cases, patients with normal breathing and heart rate may still have central cyanosis, which is often caused by insufficient blood oxygen to supply a normal heart rate or congenital malformations. This type of cyanosis that is not an indication of adequate positive pressure oxygen administration should be given 80-100% normal pressure oxygen. Once the skin turns red, the oxygen concentration should be gradually reduced to avoid oxygen poisoning.

(4) If the infant has no spontaneous breathing or heart rate <100 beats/min and still has central cyanosis after being given pure oxygen, he or she must be given pressurized oxygen immediately using a bag-mask resuscitator at a rate of 40 times per minute. The first breath requires a pressure of about 2.94 to 3.92 kPa (30 to 40 cmH2O) to expand the lungs, and only 1.47 to 1.96 kPa (15 to 20 cmH2O) is needed thereafter. For those with poor lung compliance, a pressure of 1.96 to 3.92 kPa (20 to 40 cmH2O) is required. Most children with asphyxiation can get better through this ventilation without any other treatment. However, the operator must be familiar with the principles of the device in order to use it correctly and safely.

The above knowledge is about the resuscitation method of neonatal laryngoscope. Why do we use laryngoscope? Because the child will have abnormal phenomena when or after birth, and rescue is needed to save the child's life. When we encounter such unfortunate problems, we can understand this knowledge. Of course, we all hope that every family can have a healthy and happy baby.