1 Neonatal Resuscitation, part 1 (Tintinalli)

Question 1

remarks on delayed cord clamping

Answer 1

at least 1-3 mins after birth
benefits:
-reduces the need for blood transfusion
-increases neonatal iron stores
-may decrease the risk of requiring treatment for hyperbilirubinemia

*for newborns requiring immediate intervention, the cord should be clamped and cut to allow for initiation of therapy

Question 2

most important in neonatal resuscitation

Answer 2

“Most important is the rapid establishment of effective ventilation and determining the heart rate before inititating CPR.”

Question 3

Initial steps in the first 30 seconds

Answer 3

1. If the infant is not breathing initially, dry and provide stimulation by rubbing the back 2-3x
2. if there’s no response, open the airway using jaw thrust and towels beneath the shoulders to provide a sniffing position
3. If there appearss to be obstruction from amniotic fluid, gently suction the nose and throat with a bulb or 8F catheter
4. After these initial steps, assess the respiratory effort and heart rate

Question 4

remarks on tracheal suctioning in the newborn

Answer 4

no longer recommended bec it can cause reflex bradycardia and apnea

Question 5

target O2 saturation

Answer 5

make sure preductal (right radial / hand

1 min: 60-65%
2 mins: 65-70%
3 mins: 70-75%
4 mins: 75-80%
5 mins: 80-85%
10 mins: 85-90%

Question 6

30-60 seconda:
if the heart rate is >100 bpm, but there’s persistent cyanosis or labored breathing, what to do

Answer 6

1. open the airway and suction the nose and mouth if there’s a visible obstruction
2. attach pulse oxmetry to the right hand/wrist (preductal) and apply supplemental oxygen to ahchieve targeted preductal O2 sats

Question 7

30-60 seconds:
What if heart rate <100 bpm or those who are gasping or remain apenicafter initial steps of resus

Answer 7

begin PPV using a bag and mask and room air

Question 8

remarks on chest compression in neonatal resus

Answer 8

“Bradycardia, even extreme, is typically the result of respiratory failure, and chest compressions or medications should not be intitiated until EFFECTIVE VENTILATIONS have been provided.”

Question 9

remarks on ventilation

Answer 9

40-60 breaths/min

bests indicators of effective ventilation
1. good chest rise
2. an increase in heart rate (usually within 5-10 breaths)

Question 10

steps to ensure effective ventilation prior to further resuscitation measures

Answer 10

“MR SOPA”

Mask (adjust to improve seal)
Reposition the head to open the airway

Suction the mouth then nose
Open the mouth with a jaw thrust, and increase the
Pressure until chest rise is noted (max peak ins pressure, 40 cm H20), and if none of these is effective, proceed to definitive
Airway control (endotracheal intubation)

Question 11

indication for enotracheal intubation in the neonates

Answer 11

1. absence of improvement with bag-mask ventilation
2. concomitant need for chest compressions (i.e., HR <60 bpm)
3. administration of endotracheal medications
4. known or suspected congenital diaphargmatic hernia (to avoid inflating stomach/bowel situated in the chest)

Question 12

remarks on chest compressions

Answer 12

1. done at “60-90 seconds”
2. ratio of 3 chets compressions to 1 breath for a total of 90 compressions and 30 breaths/min
3. two-thumb technique seems to be suprior in generating greater peak systolic pressures
4. two-finger technique may be more practical if a colleague is simultaneously attempting umbilical vessel catheterization
5. stop chest compressions when the heart rate exceeds 60 bpm
6. increase ventilation rate to 40-60 bpm once compression are stopped

Question 13

volume expansion in neonates

Answer 13

administer 10 mL/kg of NSS or O-negative blood when there’s known or suspected blood loss (pallor poor perfusion, or weak pulses)

Question 14

remarks on glucose levels in neonates

Answer 14

“Hypoglycemia in neonates is associated with adverse outcomes following birth asphyxia, whereas hyperglycemia is not.”

Question 15

The most readily available site for venous access in the newborn is

Answer 15

the umbilical vein

Question 16

remarks regarding discontinuing neonatal resuscitation

Answer 16

Newborns with no sign of life after 10 mins of continuous and active resuscitation are virtually certain to suffer severe morbidity and/or mortality if continued resuscitation is successfull in restoring vital signs.

Therefore, it is justified to cease resuscitative efforts after 10 mins and, certainly, after 15 mins of asystole