1.7 First Response Interventions

Question 1

Is routine airway clearance recommended?

Answer 1

• No

- Most infants are able to effectively clear their own airway

Question 2

How do you position infant to clear airway?

Answer 2

• supine with head in neutral position

Question 3

How do you clear an infants airway?

Answer 3

• Suctioning mouth/nasopharynx using 10/12F suction catheter if obvious signs of obstruction
  
  • -> Suction mouth first
  • -> Do not exceed 5-6 seconds

Question 4

When should PPV be commenced?

Answer 4

• If newborn is not breathing despite appropriate stimulation
• Commence at 40-60 inflations /min

Question 5

How do you assess effective ventilation?

Answer 5

• HR improves and increases to >100bpm
• Visible chest rise and fall
• Oxygenation increases

Question 6

If signs of effective ventilation are not observed what should you consider?

Answer 6

Consider:
- Good seal between FM and face?
> Reapply mask and create seal
> Ensure appropriate size mask

• Is head in correct position?
  > Repositon into a neutral/sniffing position
• Are you ventilating with sufficient pressure?
  > Increase pressure
• Has gas supply run out or is flow rate insufficient?
  > Ensure cylinders are not empty
  > Ensure flow rate is at least 8L/min

Question 7

Why should you not use 100% O2 during neonatal resuscitation?

Answer 7

• Increased risk of mortality
• Delayed time to first breath and cry
• Oxidative stress for up to 4 weeks

Question 8

What supplemental O2 should be provided?

Answer 8

• Term and near term newborn infants should be resuscitated in air (FiO2 21%) initially.
• Preterm infants < 35/40 initially may require air (Fio2 30%) to maintain and achieve target SpO2 of 85% at 10 minutes of age.

Question 9

Indications for supplemental O2

Answer 9

• HR does not increase to >100bpm despite effective PPV
• The infant requires CPR as HR <60bpm
• Infants HR >100bpm but Spo2 <80% at 5 minutes or <85-90% at 10 minutes of age

Question 10

Where should Spo2 probe be placed and why?

Answer 10

• Rt) hand/wrist

- Pre-ductal vessels have better perfusion and oxygenation and reflects brain stem oxygen delivery

Question 11

Target saturations at:
1 min
5 min
10 min

Answer 11

1 min: 60-70%
5 min: 80-90%
10 min: 85-90%

Question 12

What is the primary sign of effective ventilation?

Answer 12

Increase in HR

Question 13

How should you assess a newborns HR?

Answer 13

• Auscultation with stethoscope
• Palpation of umbilicus
• ECG / pulse oximetry

Question 14

When applying pulse oximetry, how long should you wait to calculate accurate HR?

Answer 14

50 seconds

Question 15

How long should it take for an infants HR to rise to 100bpm?

Answer 15

Within 1 minute without any interventions

Question 16

Indications for CPR

Answer 16

HR <60bpm post 30 seconds of PPV

Question 17

When should the FiO2 be 100%

Answer 17

Whenever chest compressions are required

Question 18

How should chest compressions be performed?

Answer 18

Chest compressions should be performed:

• Lower 1/3 of sternum
• Using 2 thumbs hands encircling or two fingers technique
• To 1/3 depth
• Allowing for full chest recoil

In conjunction with PPV (Fio2 100%) at rate 3:1

Until HR >60bpm