99465 Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output

Name of the Procedure:

Delivery/birthing room resuscitation, provision of positive pressure ventilation (PPV) and/or chest compressions.

Summary

In situations where a newborn is not breathing well or their heart is not pumping effectively right after birth, medical professionals may need to perform immediate resuscitation. This can involve providing breaths using a bag and mask (positive pressure ventilation) or performing chest compressions to help the heart pump blood effectively.

Purpose

This procedure is crucial for addressing:

• Inadequate breathing (ventilation) in a newborn.
• Poor heart function and low cardiac output.

The goal is to restore adequate breathing and heart function to prevent brain damage, organ failure, or death.

Indications

• Newborn not breathing or crying after birth.
• Weak or irregular heartbeat.
• Low oxygen levels or poor skin color (blue or pale).
• Poor muscle tone or unresponsiveness.

Preparation

• Preparing the resuscitation area with necessary equipment.
• Ensuring a trained healthcare team is present.
• Performing rapid assessment of the newborn immediately after birth.
• No specific pre-procedure instructions for the newborn (as this is an emergency procedure).

Procedure Description

1. Initial Assessment: Quickly assess breathing, heart rate, and color.
2. Stimulation: Gently stimulate the newborn to breathe.
3. Positive Pressure Ventilation (PPV):
   • Use a bag and mask to provide breaths.
   • Ensure a good seal and watch for chest rise.
4. Chest Compressions:
   • If heart rate is very low or absent, perform compressions.
   • Use two thumbs or two-finger technique at one-third the depth of the chest, at 90 compressions per minute.
5. Advanced Measures:
   • If needed, intubate or give medications as per advanced neonatal resuscitation protocols.

Equipment used includes:

• Bag-valve mask.
• Oxygen source.
• Newborn-sized masks.
• Heart rate and oxygen monitors.
• Intubation and medication tools (if advanced measures are necessary).

Duration

Typically, a few minutes to stabilize the newborn, but can vary based on response to resuscitation.

Setting

Performed in the delivery/birthing room of a hospital.

Personnel

• Neonatologists or pediatricians.
• Nurses specialized in obstetrics and neonatology.
• Respiratory therapists (in some settings).
• Midwives (in some settings).

Risks and Complications

• Potential lung injury from PPV.
• Rib fractures or organ damage from chest compressions.
• Oxygen toxicity.
• Long-term neurological issues if resuscitation is delayed or ineffective.

Benefits

• Rapid restoration of adequate breathing and heart function.
• Prevention of long-term damage to the brain and organs.
• Higher chances of survival and healthy outcomes for the newborn.

Recovery

• Continuous monitoring in the neonatal intensive care unit (NICU).
• Regular assessments of breathing, heart rate, and neurological status.
• Supportive care such as oxygen therapy, fluids, and medications.

Alternatives

• There is generally no alternative to immediate resuscitation for a non-breathing newborn.
• Prevention strategies include prenatal care and managing risk factors during pregnancy.

Patient Experience

• The newborn will not have awareness or memory of the procedure.
• Parents may experience stress or anxiety; it is important to provide emotional support and clear communication.
• Post-procedure care focuses on stabilizing the newborn and monitoring for any issues.

Pain management and comfort measures are typically not applicable to the newborn during the procedure due to their condition. However, keeping the baby warm and in a calming environment post-resuscitation is crucial.