1: Neonatal - birth asphyxia Flashcards
Define birth asphyxia
Perinatal compromise of gas exchange
What may birth-asphyxia cause
Hypoxic-Ischemic Injury
Give 5 causes of birth-asphyxia
- Placental abruption
- Cord collapse - compressing umbilical flor
- Retained lung fluid
- Pre-mature
- Maternal analgesia
When is APGAR score used to assess a child
1-minute
5- minutes
What is the one-minute APGAR score used for
Determine if the neonate requires resuscitation
What 5-minute APGAR score requires further intervention
<7
What does APGAR stand for
Appearance
Pulse
Grimace
Activity
Respiration
How will the following appear for 0-points
A. Appearance B. Pulse C Grimace D. Activity E. Respiration
A. Blue B. None C. None D. None E. None
How will the following appear for 1-point
A. Appearance B. Pulse C. Grimace D. Activity E. Respiration
A. Pink Trunk, Blue-Limbs B. <100 C. Grimace D. Flexion E. Weak cry, Slow-irregular breathing, Gasping
How will the following appear for 2-points
A. Appearance B. Pulse C. Grimace D. Activity E. Respiration
A. Pink body, Pink extremities B. Pulse >100 C. Cry, Active withdrawal D. Active motion E. Regular breathing, strong cry
Define hypoxic-ischaemic encephalopathy
Manifestation of brain-injury within 48h of birth asphyxia
How may birth asphyxia be detected antenatally
CTG:
- Late decelerations = Placental insufficiency
- Variable decelerations = Cord prolapse
What % of severe HIE will have neurological sequelae
80
If a baby has severe HIE what is ordered at 4-14days
MRI
What findings on MRI may indicate cerebral palsy
- Bilateral anomalies in BG, thalamus and internal capsule
What is the most common reason for neonatal life support
Respiratory conditions causing prolonged asphyxia leading to cardiac arrest
What is first-line in paediatric BLS
Open airway:
- Head tilt
- Chin lift
- Jaw thrust
What is second-line in paediatric BLS if neonate is not breathing
5 Rescue breathes
If no signs of life what is performed following rescue breathes
15 Chest compressions
What is the ratio of breathes to chest compressions
15:2
When should resus team be called
If alone perform 1-minute chest compressions prior to contacting resus team
In infants under 1-year what position should they be in to open airway
Neutral position with jaw thrust
In children over 1-year, what position should they be in to maintain airway
‘Sniffing air position’
With haw thrust
How long should you wait to determine patancy of the airway
10-Seconds
How many rescue breathes are given in paediatric BLS
5 rescuer breathes
What pulses should be checked for life in infants and children
Children: carotid
Infants: brachial and femoral
When should chest compressions be started
No pulse in 10-seconds
What are indications for chest compressions
- No pulse
- Or, HR <60
- No signs life
What technique is used for chest compressions in infants
Encircling technique: place hands around lower-sternum and use thumbs for CPR
Define hypoxic ischaemic encephalopathy
Clinical presentation brain injury due to hypoxic-ischaemic insult
How can cause of HIE be divided
Antenatal
Perinatal
Postnatal
What causes HIE
Umbilical cord prolapse
Placental abruption
What are mild symptoms of HIE
- Hyperventilation
- Hyper-responsive
- Irritable
- Impaired feeding
What are moderate symptoms of HIE
- Reduced movement
- Lethargy
- Seizures
What are severe symptoms of HIE
- Hypotonia
- No movement
- Prolonged seizures
- Multi-organ failure
Explain management of HIE
- Resuscitation
- Therapeutic hypothermia
- Cerebral function analysis monitoring (CFAM)
- Withhold feeding 1-2d and re-introduce gradually
What are the three indications for therapeutic hypothermia
- Infant >1.8Kg and >36W with one of:
- Cord gas or ABG with acidosis (pH <7)
- APGAR < 5 at 10-minutes - Moderate to severe HIE:
- Hypotonia
- Seizures
- Hyporeflexia
If criteria 1 or 2 are met, test for criteria 3
- 30-minutes seizure activity on cerebral function analysis monitoring
What is standard of care of infants with moderate-severe HIE
Therepetic hypothermia
What is therapeutic hypothermia
Uses temperature control mat to maintain infants body T between 33-34’
How long is therapeutic hypothermia maintained for
72-hours
What are 5 complications of HIE
- Spastic quadriplegia
- Dyskinetic cerebral palsy
- Low IQ
- Cortical blindness
- Hearing loss
- Epilepsy
