3.1 - Neonatal Resuscitation - Exam

Question 1

Exam: Identify risk factors that may result in the newborn requiring resuscitation

Answer 1

Maternal
* Prolonged rupture of membranes (greater than 18 hours)
* Bleeding in second or third trimester
* Hypertension in pregnancy
* Substance use
* Prescribed medication (e.g. lithium, magnesium, adrenergic blocking
agents, narcotics, selective serotonin reuptake inhibitor)
* Diabetes mellitus
* Chronic illness (e.g. anaemia, congenital cyanotic heart disease)
* Maternal pyrexia
* Maternal infection
* Morphine given within 4 hours of birth
* Chorioamnionitis
* Heavy sedation
* Previous fetal or neonatal death
* No/minimal antenatal care

Fetal
* Multiple gestation
* Preterm gestation (especially less than 35 completed weeks)
* Gestation greater than 41 completed weeks
* Large for dates based on ultrasound estimation of fetal weight
* Fetal growth restriction
* Alloimmune haemolytic disease (e.g. anti-D, anti-Kell, especially if fetal or
other antibody known to cause haemolytic disease in the fetus or baby
especially if fetal anaemia or hydrops fetalis present)
* Polyhydramnios and oligohydramnios
* Reduced fetal movements before onset of labour
* Congenital abnormalities which may affect breathing, cardiovascular
function or other aspects of perinatal transition
* Intrauterine infection
* Hydrops fetalis

Intrapartum
Intrapartum2
* Abnormal fetal patterns on cardiotocograph (CTG)
o Refer to Queensland Clinical Guideline: Intrapartum fetal surveillance16
* Abnormal fetal presentation
* Cord prolapse
* Prolonged first or second stage of labour
* Precipitate labour
* Antepartum haemorrhage (e.g. abruption, placenta praevia, vasa praevia)
* Meconium in the amniotic fluid
* Narcotic administration to mother within 4 hours of birth
* Assisted vaginal birth–forceps or vacuum (ventouse)
* Maternal general anaesthesia

Question 2

Exam: Justify choice of resuscitation equipment and how this is prepared

Answer 2

• ensure check resus cot before baby is born regardless if the cot have been checked prior in the shift
• T-piece
• Neo Puff - ensuring that it seals well and the size in correct
• Suction tubing if required
• pluse oximeter to measure O2 sats and HR - right hand or wrist - preductal
• stethoscope
• know the peep & pip pressures
• ETT tube
• bag and mask - usually used in a case where the resus cot is not available ie lift community

Question 3

Exam: Describe assessment of the newborn related to resuscitation

Answer 3

Question 4

Exam: Outline and provide rationale for first response newborn resuscitation

Answer 4

First Response covers the initial assessment and care of the newborn infant undergoing transition to extrauterine life and provides the participant with the opportunity to gain confidence and competence in:

The initial steps of assessment of the newborn infant
Determining if the infant requires assistance to establish and maintain effective breathing
Assisting the infant to breathe using a variety of positive pressure ventilation devices
Providing external chest compressions if effective positive pressure ventilation fails to restore an adequate heart rate and circulation.

Question 5

Exam: Describe the indications for and elements of advanced resuscitation

Answer 5

Advanced Resuscitation prepares the participants for ongoing resuscitation of a newborn in whom First Response interventions have failed to achieve spontaneous breathing and adequate cardiac output and circulation. Participants are provided with the opportunity to gain confidence and competence in:

Endotracheal intubation and endotracheal tube strapping
The administration of drugs to improve cardiac output and contractility
Insertion of an umbilical venous catheter or intraosseous needle to establish vascular access
Administration of volume expanders including blood products and 0.9% sodium chloride to treat hypovolaemia and shock
Attendance at a First Response program is not a prerequisite for attending this program, as all components of the First Response program are included.

Question 6

Exam: download the ANZCOR neonatal guideline

Answer 6

Question 7

Exam: Use the flowchart to annotate/make notes against each step with “tips”, ‘rationale’ ‘hints’ words of widson
that you have gleaned from the resources and what you have experienced clininally

Answer 7

• 123 breathe
• 123 breath3
• always reassess hr after 30 seconds
• keep baby warm
• tap out the heart rate
• if giving breaths only deliver 60 breaths
• if CPAP on watch for rise and fall of the chest

Question 8

resus

Answer 8

• peak inspiratory pressure (PIP)
• positive end-expiratory pressure (PEEP).

Question 9

CPAP

Answer 9

• continuous positive airway pressure”

Question 10

PEEP

Answer 10

• positive end expiratory pressure
• set at 5.

Question 11

PIP

Answer 11

• peak inspiratory pressure
• 30 cmH2O for a term infant
• 20 – 25 cmH2O for a preterm infant
• 30% o2 for 32 week

Question 12

Targeted preductal SpO2 after birth

Answer 12

preductal
1min 60-70
2 min 65-85
3 min 70-90
4 min 75-90
5 min 80-90
10 min 85-90

Question 13

IV Adrenaline 1:10,000 solution

Answer 13

23 -26 w 0.1ml
27 -37 0.25ml
38-43 0.5 ml

10-30 microg/kg (0.1 - 0.3 ml/kg)

Question 14

preterm <32 or less than <1500 grams

Answer 14

placed immediately into a polyethylene bag or wrap while still wet and warm,

Question 15

transition

Answer 15

The transition from the fetal to the neonatal circulation thus includes elimination of the placental circulation, lung expansion,
increase in lung blood flow so that the entire cardiac output can be accommodated, and
closure of the foramen ovale, ductus arteriosus, and ductus venosus.

Question 16

Closure of the ductus arteriosus and umbilical artery are facilitated by

Answer 16

decreases prostagladin and increase po2

Question 17

The change in the neonate lungs from being fluid filled to air filled results in

Answer 17

pulmonary arterioles dilating and reduced vascular resistance in the lungs which increases blood flow

Question 18

What is the purpose of pre-ductal oximetry?

Answer 18

It measures the arterial oxygen saturation in vessels coming from the aorta before it is mixed with pulmonary blood at the level of the ductus arteriosus that is still patent in the minutes following birth