Neonatal Resuscitation

Question 1

Discuss the differences in the lungs and circulation between the fetus and after delivery.

Answer 1

The airways and the alveoli must be cleared of fluid to allow adequate gas exchange.

Pulmonary blood flow must increase and spontaneous respirations must be established

An increase in systemic vascular resistance following clamping of the cord in combination with decreased pulmonary vascular resistance leads to functional closure of the ductus arteriosus

It is issues with this transition which leads to the apnoeas and the need for resuscitation.

Question 2

What is primary apnoea following the birth of a baby?

Answer 2

Primary Apnoea
•Rapid attempts to breathe
•Respirations cease
•Heart rate decreases
•BP usually maintains and can increase a bit
o	Increase blood flow to the brain
•Responds to stimulation
o	Rub them a little and then the baby will start to breath

Question 3

What is secondary apnoea following the birth of a baby?

Answer 3

Secondary Apnoea
•Respirations cease
•HR decreases
•BP decreases
•No response to stimulation
•When a baby comes out –> assume secondary after drying the baby.
o Give the baby respiratory support
•Take big but irregular gasping breathes to establish lung volume –> then will stop breathing and this is when HR drops and BP drops –> need to get the baby back to the breathing end because if they go into secondary apnoea then its game over.
o This occurs over a 10-20 min period. Need to do something about the secondary apnoea because babies will not get out of it. Dry the baby, tactile stimulation and no breathing then you have to give the baby respiratory support

Question 4

What is an APGAR score and what are its components?

Answer 4

A = Appearance (Colour)
P = Pulse (HR)
G = Grimace (Irritability)
A = Activity (tone)
R = Respiratory (Respiratory Effort)

Question 5

What are the scores for each of the components?

Answer 5

A = Appearance (Colour) = Blue,pale – Body pink, extremities blue – complete pink
P = Pulse Rate = Absent - 100/min
G = Grimace (irritability) =  No response – Grimace – Cough/Cry
A = Activity (Tone) =  Limp – Some flexion of extremitis – Active motion
R = Respiratory (Respiratory Effort) = Absent – slow,irregular – cough/cry

Question 6

When do you assess APGAR scores? Do you wait for the APGAR score to commence resuscitation?

Answer 6

Assess APGAR at 1min and 5min.
If 7
DO NOT wait to assign APGAR score to begin resuscitation

Question 7

What are the 5 signs of a compromised newborn?

Answer 7

• The baby is not crying
• The baby is not breathing or gasping
• The baby is very floppy
• There is bradycardia
• There is persisting cyanosis

Question 8

What are the main steps involved in the initial resuscitation prior to the ABC?

Answer 8

Anticipation: Maternal Hx, Obs Hx (pregnancy, labour, delivery)
Warm + Dry the newborn (radiant heater, warm towels)
Position and clear the airway (“sniffing” position)
Stimulate the infant: rub the lower back gently or flick soles of feet
Assess the breathing and heart beat

Question 9

What are the ABCs and what are the main points of this part of the resuscitation?

Answer 9

Airway

• Decide if the baby is vigourous (strong resp effort, good muscle tone, HR>100) or not vigourous
• If vigourous – no further resuscitative interventions required
• If not vigourous – intubate and suction trachea while monitoring vital signs.

Breathing
-If HR

Question 10

What are some signs of correct positioning of the endotracheal intubation?

Answer 10

• Colour change on the CoO2 detector
• Seeing the ETT passing through the larynx
• Improvement in SpO2 and HR
• Chest rises with each breath
• Breath sounds over both lung fields
• No gastric distension with ventilation
• Vapor condensing on the inside of the tube during exhalation

Question 11

How do you manage the temperature in a newborn and why is this important?

Answer 11

Important because hypothermia can increase O2 consumption and impede effective resuscitation
Keep an ambient temperature of 26 degrees, use polythene sheet or bag for babies

Question 12

What are the 3 medical interventions that can be used if necessary in a neonatal resuscitation?

Answer 12

Adrenaline – If HR

Question 13

What is important in the aftermath of a resuscitation for both the newborn infant and the family?

Answer 13

Newborn – monitoring should include SpO2, HR and Respiratory Rate. Capillary blood gas may be indicated. Blood pressure and blood glucose should be checked and documented soon after the resuscitation.
Family – appreciate the distressing nature of the resuscitation and appropriate measures should be taken to support the family.