1.1 ANZCOR New Born Life Support

Question 1

How do you assess a newborn for the need to initiate and/or continue resuscitation?

Answer 1

• Is the infant term gestation? (>/= 38/40)
• Is the infant breathing or crying?
• Does the infant have good muscle tone?

Question 2

Once born, what signs indicate a newborn should be moved to the resuscitaire for further assessment?

Answer 2

• Floppy

- Not moving and/or breathing or crying

Question 3

What are pre-term babies at particular risk of? How should this be managed?

Answer 3

• Hypothermia

Mx:
- <32/40 (and esp <28/40) +/- <1500g
> place immediately in polyethylene bag whilst wet and warm
> place under heat lamp on resuscitaire

• > 32/40 - 37/40
  dried off
  placed under heat lamp on resuscitaire

Question 4

What assessment should occur of neonates once immediately bone?

Answer 4

• Temperature
• Tone
• Breathing effort
• HR

Question 5

What does stimulating an infant involve?

Answer 5

• Tactile stimulation of newborn to induce effective breathing where suction/drying do not succeed
• Gentle rubbing of trunk/back/extremities using pre-warmed towels

Question 6

How long should stimulation be attempted at a maximum before moving the infant to the resuscitaire? What signs indicate effective stimulation?

Answer 6

• HR > 100 bpm
• Effective breathing
• Performed for a maximum of 20 seconds

Question 7

What do first response interventions involve?

Answer 7

• Airway
• Breathing
• Circulation

–> Advanced resuscitation measures (e.g. intubation/drugs) may be required if these fail

Question 8

Neonatal first response: Airway

Answer 8

• Position infant supine with the head in a neutral position.
• Clear airway if obvious signs of obstruction
• Dry the infant and stimulate the infant to breathe.
• Maintain warmth. Aim 36.5 and 37.5° in non-asphyxiated newborns

Question 9

What is the optimal position to maintain a neonates airway?

Answer 9

Supine with head in neutral position

Question 10

What temperature range is optimum for a non-asphyxiated newborn?

Answer 10

36.5-37.5

Question 11

Neonatal first response: Breathing

Answer 11

• If not breathing or the <100 bpm in infant with poor muscle tone breathing ineffectively, then positive pressure ventilation (PPV) is indicated.
• Provide PPV at a rate of 40 – 60 inflations/min. Aim for an inspiratory time of 0.3 - 0.5 sec.
• Start PPV:
  > Term infants: in air (21%)
  > Pre-term infants <35/40: in air or up to 30% O2
• Apply a pulse oximeter to the infant’s right hand or wrist.
• Titrate supplemental O2 administration according to SpO2 (wean O2 if SpO2 >90%).
• Reassess the infant after 30 seconds of effective PPV.

Question 12

When assessing a newborn for their breathing, what signs indicate PPV is required?

Answer 12

• Not breathing OR

- HR <100 bpm with poor muscle tone + ineffective breathing

Question 13

What rate and flow of PPV should be provided in neonatal resuscitation?

Answer 13

• Inflations: 40-60 /min
• Inspiratory time: 0.3-0.5 seconds

> Term infants: in air (FiO2 21%)
Pre-term infants: in air or up to FiO2 30%

Question 14

Where should a pulse oximeter be attached to an infant? Why?

Answer 14

• Right hand or wrist

Question 15

What should you aim Spo2 in a newborn?

Answer 15

> 90%

Question 16

Neonatal first response: Circulation

Answer 16

• If HR 60-100bpm: continue PPV until HR >100bpm and infant is breathing spontaneously and effectively
• If HR <60bpm: commence CPR and PPV at ratio of 3:1
• -> Increase FiO2 to 100%
• -> Reassess HR after 30 seconds of effective CPR with PPV
• If HR >60bpm: CPR can be ceased and PPV can be continued at 40-60 inflations/min until HR >100bpm and infant breathing effecively
• If HR <60bpm: advanced resuscitation (IV access and drugs) is required

Question 17

When assessing a neonates HR, what range indicates PPV should be continued?

Answer 17

60-100 bpm

- continue PPV until HR >100bpm and infant is breathing spontaneously and effectdsively

Question 18

When assessing a neonates HR, what range indicates CPR should be commenced?

Answer 18

<60bpm

- Commence CPR and PPV at ratio of 3:1 with FIO2 100%

Question 19

When performing CPR with PPV, after how long should the HR be reassessed?

Answer 19

30 seconds

Question 20

When re-assessing an infant’s HR post 30 seconds of CPR with PPV what range indicates CPR can be ceased?

Answer 20

HR >60bpm

• Cease CPR
• Continue PPV at 40-60 inflations/min until HR >100bpm and infant breathing effectively

Question 21

When re-assessing an infant’s HR post 30 seconds of CPR with PPV, what range indicates ongoing resuscitation is needed?

Answer 21

<60bpm

• Continue CPR with PPV at 3:1 ratio
• Activate ALS algorithm

Question 22

Neonatal first response: Drugs

Answer 22

• If HR <60bpm despite effective CPR with PPV - adrenaline indicated
• If shocked/blood loss is suspected - consider volume expanders

Question 23

When should endotracheal intubation be considered?

Answer 23

• If no detectable HR at birth

- If PPV with mask fails to restore adequate HR

Question 24

Draw a diagram of the Newborn Life Support diagram

Answer 24

See

https://www.neoresus.org.au/learning-resources/key-concepts/summary/