Universidad de Costa Rica

Presentación del tema: "Universidad de Costa Rica"— Transcripción de la presentación:

1 Universidad de Costa Rica
Cuidados del Recién Nacido, Transición y Adaptación.

2

3 CUIDADOS DEL RECIEN NACIDO
Los cuidados del recién nacido son aquellas atenciones que el personal de salud provee a un recién nacido a fin de permitirle la adecuada adaptación al medio extrauterino. Consta de varios pasos, todos igual de importantes.

4 CUIDADOS DEL RECIEN NACIDO
Aspirar la vía aérea (discutible) Colocar en una área seca y precalentada. Aspirar la vía aérea=posición de olfateo. Secar todo el cuerpo especialmente la cabeza. Evaluar Aplicar reanimación neonatal si es necesario. Estabilizar Atención inmediata. Calostro.

5 Atención inmediata MEDIDA OBJETIVO Tetraciclina oftálmica
Conjuntivitis gonocóccica Permeabilidad del esófago Atresia de esófago Permeabilidad anal Atresia anal Ligadura y limpieza del cordón umbilical Sangrado. Sepsis. Identificación Confusión de identidad Medidas antropométricas Clasificación según tablas. Vacunación (hepatitis, BCG) Prevenir hepatitis B, TB miliar y meníngea

6 examen físico Cabeza Cuello Tórax Abdomen Genitales externos
Miembros superiores Miembros inferiores Reflejos del recién nacido Exámen neurológico Conclusiones diagnósticas examen físico

7 Visión general y principios de la reanimación
Determinar el riesgo del niño para requerir reanimación, Proveer calor Posicionar y liberar la vía aérea Secar y estimular la respiración Oxígeno si fuera necesario Ventilación con PP Intubación endo- traqueal Compresiones Drogas Necesario para todos los recién nacidos Necesario con menos frecuencia Necesario muy raramente

8 Todos recién nacidos necesitan una evaluación inicial para determinar si requieren o no reanimación.
 The flow diagram begins with the birth of the baby. Each resuscitation step is shown in a block. Below each block is a decision point to help decide whether proceeding to the next step is needed. At the time of birth, you should ask yourself 4 questions about the newborn. These questions are shown in the Assessment block. Term gestation? Amniotic fluid clear? Breathing or crying? Good muscle tone? If any answer is “no,” you should continue to the next steps.

9 Seque, estimule para que respire, reposicione
Often, positioning the newborn and suctioning secretions will provide enough stimulation to initiate breathing. Drying also will provide stimulation. Drying the body and head also will help to prevent heat loss. While drying the baby, keep the head in the “sniffing” position to maintain a good airway. As part of preparation for resuscitation, several pre-warmed absorbent towels or blankets should be available. Instructor Tip: Towels are often more absorbent than blankets. Handle a limp baby carefully. Without protective muscle tone, the baby can be injured if moved roughly or carelessly.

10 Proveer calor Prevenga la pérdida de calor de la siguiente manera:
Colocando al recién nacido bajo una cuna de calor radiante. Secándolo completamente. Removiendo paños húmedos. Cangurear. Prevention of heat loss is critical during resuscitation. Place the newborn in a preheated overhead radiant warmer. It is important to preheat the radiant warmer so that the newborn is placed on a warm mattress. Instructor Tip: Do not pre-warm blankets or towels by placing them on top of the warmer, because of the risk of fire. Put the newborn’s head at the foot of the warmer for easy access to the airway. Quickly dry the newborn with a warm towel to remove amniotic fluid and prevent evaporative heat loss. This act of drying also provides gentle stimulation, which may initiate or help maintain breathing. The exception is when meconium is present in the trachea. Then it is preferable to delay stimulation that may be caused by drying until the meconium has been suctioned from the trachea. It is imperative to remember to remove wet towels. Don’t block the radiant heat with towels, blankets, or team members’ heads or upper bodies. Very preterm newborns may require placement, below the neck, in a food-grade plastic reclosable bag without drying to prevent heat loss. (See Lesson 8.) A pre-warmed overhead radiant warmer minimizes radiant heat loss and allows access to, and visualization of, the newborn.

11 despejando la vía aérea en ausencia de meconio
Succione boca primero, luego nariz “B” antes de “N” If no meconium is present, simply suction the mouth, then nose, with a bulb syringe. The mouth is suctioned before the nose to ensure that there is nothing for the newborn to aspirate if he or she should gasp when the nose is suctioned. If the newborn has copious secretions coming from the mouth, turn the head to the side so that secretions will collect in the cheek and be easily removed. Haga click en la magen para ver el video

12 despejando la vía aérea
Via Aérea permeable no obstruccion al paso de aire The newborn should be placed on his or her back, with the neck slightly extended. Care should be taken to prevent hyperextension or flexion of the neck, since either may decrease air entry. To help maintain correct position, you may place a rolled blanket or towel under the shoulders, elevating them three fourths of an inch to 1 inch off the mattress. This roll may be particularly useful if the newborn has a large occiput. Correct positioning allows an open airway to be maintained. In addition, the newborn will be in the optimal position if assisted ventilation becomes necessary. Cuello flexionado obstruccion al paso de aire Cuello hiperextendido obstruccion al paso de aire

13 optimizando la vía aérea
Abra la vía aérea posicionando al recién nacido en posición de “olfateo Posicione sobre la espalda o de lado, extendiendo ligeramente el cuello La posición de “olfateo” alinea la faringe posterior, laringe y tráquea. Once the newborn has been placed under a preheated radiant warmer and dried, the next step is to ensure “A” of the ABCs—establishment of an open airway. Correct positioning of the newborn will bring the posterior pharynx, larynx, and trachea in line, which will facilitate unrestricted air entry. Instructor Tip: Although positioning before suctioning is suggested, if meconium is not present, you may position the newborn before or after suctioning. The important point is that opening the airway consists of both suctioning and positioning.

14 Cianosis central y acrocianosis
Central cyanosis is caused by too little oxygen in the blood and causes a blue hue to the lips, tongue, and central trunk. Acrocyanosis is a blue hue to the hands and feet. Only central cyanosis requires intervention. Instructor Tip: Even babies who will eventually become heavily pigmented will appear “pink” when adequately oxygenated after birth. The issue of resuscitation with room air versus supplemental oxygen is further discussed in Lessons 3 and 8. Cianosis central

15 estimulación táctil adecuada
If, after drying and repositioning, the newborn does not have adequate respirations, additional tactile stimulation may be provided briefly to stimulate breathing. Safe and appropriate methods of providing additional tactile stimulation include Slapping or flicking the soles of the feet Gently rubbing the back, trunk, or extremities Haga click en la imagen para ver el video

16 formas inadecuadas de estimulación
Golpes fuertes en las plantas Apretar la caja torácica Nalgadas Sacudir al niño Overly vigorous stimulation is not helpful and can cause serious injury. The forms of stimulation listed in this slide may cause bruising, fractures, tearing of internal organs, brain damage, or other consequences. If a baby is in primary apnea, almost any gentle stimulation will initiate breathing. If a baby is in secondary apnea, no amount of stimulation will work.

17 Compromiso en útero o perinatal
Apnea primaria Cuando el feto/neonato sufre una primera deprivación de oxígeno, hay un período inicial de intentos de respiraciones rápidas seguido de apnea primaria (detención de la respiración) y descenso de la frecuencia cardíaca que mejora con estimulación táctil. When babies are deprived of oxygen (in utero or after delivery), they undergo a well-defined sequence of events that starts with cessation of respiration. Primary apnea follows the sequence noted on this slide. An important point is that, during primary apnea, the newborn responds to stimulation. Instructor Tip: Initiate resuscitation immediately. Resuscitation may be inappropriately delayed if the health care provider does not recognize the need for neonatal resuscitation. Any delay in transferring a compromised newborn to the resuscitation team is unacceptable practice.

18 apnea secundaria Si la deprivación de oxígeno continúa, se produce una apnea secundaria acompañada por una caída continua en la frecuencia cardíaca y en la presión arterial. La apnea secundaria no puede ser revertida con estimulación; debe proveerse ventilación asistida. If oxygen deprivation continues, deep gasping respirations develop, the heart rate continues to decrease, and the blood pressure decreases. An important point is that, during secondary apnea, stimulation will not restart the baby’s breathing. Assisted ventilation must be provided to reverse the process triggered by oxygen deprivation. If a baby doesn’t begin to breathe immediately after being stimulated, he or she is likely in secondary apnea and will require positive-pressure ventilation. Instructor Tip: Quickly achieve and maintain oxygenation in full-term and post-term newborns after perinatal hypoxia-ischemia because they are especially prone to persistent pulmonary hypertension. Haga click en la imagen para ver el video

19 signos de un neonato comprometido
Pobre tono muscular Pobre esfuerzo respiratorio Bradicardia Presión arterial baja Taquipnea Cianosis Buen tono con cianosis The compromised baby may exhibit one or more of the following clinical findings: Poor muscle tone Depression of respiratory drive due to insufficient oxygen reaching the brain Bradycardia Low blood pressure Cyanosis (blue color) Tachypnea (rapid respirations) Other conditions, such as infection, hypoglycemia, or depressant drugs given to the mother before birth, may also cause these symptoms. Mal tono con cianosis

20 fisiología fetal Alvéolos están llenos de líquido pulmonar.
En el feto: Alvéolos están llenos de líquido pulmonar. En útero, el feto depende de la placenta para el intercambio gaseoso. In the fetus, oxygen is transferred across the placenta, and the lungs contain no air. The alveoli (potential air sacs) of the fetus are filled with fluid that has been produced within the lungs.

21 fisiología fetal En el feto:
Las arteriolas pulmonares están contraídas. El flujo sanguíneo pulmonar disminuido El flujo sanguíneo se desvía a través del conducto arterioso. Blood flow through the fetal lung is markedly diminished compared with that required after birth, as the pulmonary arterioles are constricted and blood flow is diverted across the ductus arteriosus. Haga click en la imagen para ver el video

22 Los siguientes cambios suceden segundos después del nacimiento:
lo que sucede después de la primera respiración… Los siguientes cambios suceden segundos después del nacimiento: Se absorbe el líquido alveolar Cuando se pinzan las arterias y vena umbilical aumenta la presión arterial sistémica. Los vasos sanguíneos del pulmón se dilatan. after birth. Normally, there are 3 major changes that take place within seconds Alveolar fluid is absorbed into lung tissue and replaced by air. Umbilical arteries and veins are clamped, removing the low resistance placental circuit and increasing systemic blood pressure. Blood vessels in lung tissue relax, increasing pulmonary blood flow. Haga click en la imagen para ver el video

23 los pulmones y la circulación después del nacimiento…
Vasos sanguineos contraidos antes del nacimiento Vasos sanguineos dilatados después del nacimiento Los pulmones son expandidos con aire. El líquido pulmonar sale de los alvéolos. Las arteriolas pulmonares se dilatan El flujo sanguíneo pulmonar aumenta At birth, as the newborn takes the first few breaths, several changes occur, whereby the lungs take over the lifelong function of respiration. Following birth, the lungs expand as they are filled with air. The fetal lung fluid gradually leaves the alveoli. Liquido Alveolar Oxigeno alveolar

24 Los Pulmones y la Circulación
Los niveles de oxígeno sanguíneo se elevan El ductus arterioso se contrae. La sangre fluye a través de los pulmones para oxigenarse As blood levels of oxygen rise, the ductus arteriosus begins to constrict. Blood previously diverted through the ductus arteriosus flows through the lungs, where it picks up oxygen for transport to tissues throughout the body. The ductus remains constricted, and the normal extrauterine circulatory pattern is established. Los Pulmones y la Circulación 24

25 problemas durante la transición
La falta de ventilación de los pulmones del neonato lleva a una constricción sostenida de las arteriolas pulmonares, evitando que la sangre arterial sistémica se oxigene. La falta prolongada de perfusión y oxigenación a los órganos del niño puede causar daño cerebral, lesiones a otros órganos, o la muerte. A baby may encounter difficulty before labor, during labor, or after birth. Some of the problems that may disrupt normal transition are The baby may not breathe sufficiently to force fluid from the alveoli, or foreign material such as meconium may prevent air from entering the alveoli. Excessive blood loss may occur, or there may be inadequate cardiac contractility or bradycardia from hypoxia and ischemia. Lack of oxygen or ventilation of the newborn’s lungs results in sustained constriction of the pulmonary arterioles, preventing arterial blood from becoming oxygenated. Prolonged lack of adequate perfusion and oxygenation to the baby’s organs can lead to brain damage, damage to other organs, or death.

26 prematuros… Deficiencia de factor surfactante pulmonar
Disminución del esfuerzo respiratorio Respiración espontánea difícil por músculos débiles Rápida pérdida de calor, pobre control térmico Mayor riesgo de - Hemorragia intracraneana - Infección - Hipovolemia secundaria a pérdida sanguínea Tejidos inmaduros susceptibles a daño por oxígeno: Retinopatía del prematuro, displasia broncopulmonar.

27 El 80% de los RN < de 32 semanas ameritan reanimación neonatal.
Presentan inmadurez anatomica y fisiológica: Piel.Delgada, extensa con respecto a la masa corporal, poca grasa. Músculos débiles.=> Dificultad respiratoria. Inmadurez tisular retiniana => ROP Inmadurez SNC=> Insuficiencia respiratoria. Pulmones inmaduros =>Membrana Hialina. Inmadurez inmunológica => Infecciones. Fragilidad vascular => cerebral. HIC Volumen sanguíneo pequeño => Anemia por pérdidas . prematuridad

28 prematuridad

29 Pasos …Repaso Proveer calor
Posicionar la cabeza y despeje la vía aérea como sea necesario* 3. Secar y estimular al bebé para que respire. 4. Evaluar. 5.Cuidados inmediatos