ERC - Babies At Birth Flashcards
A baby is born and doesn’t immediately breathe, what is your first step
Dry them - provides tactile stimulation which is often enough to stimulate breathing
What temperature should a baby just born be kept at
36.5-37.5
How do you measure the heart rate in a newborn baby
ECG is first choice or…
With a stethoscope over the apex beat
Pulse ox
What signs indicate that a newborn baby needs resuscitation
Gasping, not breathing, HR <100
A newborn baby is not breathing or has a HR <100, what now
Open the airway using jaw thrust with the head in a neutral position
5 rescue breaths maintained for 2-3 seconds each
How do you open the airway in a newborn
Keep the head in a neutral position and do a jaw thrust
If they have poor tone consider OPA
Why is suction not recommended unless absolutely necessary in a newborn baby
Can stimulate vagal induced bradycardia
What is the diving reflex seen in newborns
On flexion of the neck (pressing too hard on mask) the baby goes bradycardic and apneoic
You have given 5 breaths to a newborn baby and there HR increases but they aren’t breathing adequately, what do you do
Ventilate at 30/minute with inflation time of 1s
The newborn baby is not improving after after the 5 initial rescue breaths, what do you do
Recheck the airway
try 2 person technique
Further 5 rescue breaths
The newborn baby has a heart rate <60 or no detectable heart rate despite adequate ventilation, what do you do
Start CPR on a ratio of 3:1 (90 compressions to 30 ventilations in a minute)
Simple airway manoeuvres are still not working in your newborn baby, what other steps can you take
PEEP may be needed if apnoeic
Intubate
PPV with 21% O2 (although can be increased if absolutely necessary)
Under what conditions would you start CPR in a newborn
HR <60 or not detectable despite adequate ventilation
What can lead to false positives and false negatives on ETCO2 in a newborn baby
+ve: contamination with surfactant, adrenaline or atropine
-ve: tracheal obstruction, poor pulmonary flow
Describe how you would perform CPR in a newborn baby
Wrap your hands around the torso with 2 thumbs placed on the lower half of the sternum
Compress 1/3 of the AP diameters
Ratio of 3:1
Aim for 90 compressions to 30 ventilations/ minute
When might you not do the standard 3:1 newborn compression:ventilation ratio
If you suspect the cause to be cardiac (eg known cardiac abnormality on antenatal scans) can do 15:2
How would you deliver drugs to a newborn baby
Via an umbilical vein catheter
Describe a cross section of an umbilical cord
1 vein
2 arteries
When would you give bicarbonate to a newborn
If all else has failed in a prolonged arrest you can give bicarb
What does bicarbonate do to a newborns myocardial and cerebral function and why
reverses intracellular acidosis which could improve myocardial function but
causes hyperosmolaity and creates CO2 therefore reducing cerebral and myocardial function
If giving blood to a newborn, what type does it need to be
O
Rhesus -ve
Leukocyte depleted
Irradiated
When would you stop resuscitation efforts in a newborn
10 minutes of no improvement
How long would you expect it to take for a newborn to pink up
Maximum 30 seconds
A preterm baby is in respiratory distress, what do you need to do
CPAP
A newborn baby is breathing, has a good HR but is cyanotic, what could be going on
Congenital cyanotic heart disease Diaphragmatic hernia Surfactant deficiency Pneumothorax Pneumonia
When would you consider suction in a newborn infant
Only if there is thick, viscous meconium causing an airway blockage
what needs to happen for fetal to neonatal transition
Clear fetal lung fluid
Aerate the lungs
Establish a pattern of breathing
What happens to the HR when there is immediate cord clamping and why
Bradycardia
The reduced pulmonary vascular resistance on taking a breath leads to increase pulmonary blood flow and an immediate decrease in heart size before after a few cardiac cycles it increases again as blood is returned from the pulmonary circulation
When should the cord be clamped
> 1 minute
What happens to a newborns arterial oxygen tension if they get cold and what happens as a result
Reduced arterial oxygen tension
Metabolic acidosis
How can we help to maintain a new born babies temperature
Warm towels to dry Put them onto mum No air conditioning Closed windows Polyethylene wraps and under a heater if <32 weeks
A pre-term infant requires ventilatory support, what % O2 should this be with
ideally air (21%) but up to 30% and if this still isn’t working you can titrate up
what inflation time should be used when performing 5 rescue breaths in a newborn
2-3 seconds
state the tracheal tube lengths by gestational weeks
all lengths given in cm 23-24: 5.5 25-26: 6 27-29: 6.5 30-32: 7 33-34: 7.5 35-37: 8 38-40: 8.5 41-43: 9
What PEEP should be given for preterms receiving PPV
5cm H2O
what is the combined APGAR score
scores the interventions needed + the parameters are also scored but regardless of the interventions that are required to achieve these parameters
