ROLE OF THE ANAESTHESIOLOGIST IN NEONATAL RESUSCITATION AND CARE OF THE NEWBORN

Abstract

Resuscitation of infants and children is different from adult resuscitation. Although there may be many similarities in the methodologies used in the resuscitation procedures with those used in adults, pediatric life support is governed by the fact that it begins from a different starting point. Adult sequences are based on the observation that the majority cf cases are primarily cardiac in origin, arrest is therefore rapid and immediate in onset giving little or no warning of occurrence and usually requiring rapid defibrillation to achieve any measure of success (Dieckmann, 1995).

In infants and children the cause is usually primarily a respiratory event which leads to the final cardiac arrest if not recognized and death with promptly. Primary cardiac arrest in children is rare and ventricular fibrillation and ventricular tachycardia have been reported in less than 15% of the young (Appleton, 1995).

The aetiology and pathogenesis of sudden death in this age group is therefore important. Many children have a relatively long "pre-arrest" phase, cardiac arrest signalling the end of a progressive physiological decline. It could be argued that in such events many deaths could be prevented by early recognition and aggressive therapy in this "pre-arrest" phase but, unfortunately, some remain irreversible despite all efforts (Baskett, 1996).