Lesson 8-9

Question 1

Compared to babies born at term, preterm babies have: (11)

Answer 1

-a higher surface to body mass ratio
-thinner skin
-less subcutaneous fat
-limited ability to metabolically respond to cold temps. &/ Low blood sugar
-weaker chest muscles
-more flexible at chest wall/ribs
-less surfactant in alveoli
-alveoli that are more sensitive to concentrated oxygen and air pressure
-lower blood volume
-a vulnerable brain vasculature
-greater susceptibility to infection (pneumonia, sepsis)

Question 2

If you know baby is being born preterm what steps should you take to prepare?

Answer 2

-preheat radiant warmer
-increase room temp to 74°-77°
-put hat on baby and keep baby wrapped up
-place baby on preheated thermal mattress, wrap in polythene wrap or bag (>32 - <35 week gestation)
-transport in incubator

Question 3

Avoid over/under heating preterm baby, axillary temp should be

Answer 3

36.5 - 37.5°c

Question 4

For premature babies there are a few adjustments to ventilation techniques. Use ____ instead of ETT if baby has ______ &/ ______ ONLY if baby is breathing spontaneously and heart rate is at least _____

Answer 4

CPAP, labored breathing, poor oxygen saturation (cyanosis)

100bpm

Question 5

Preterm babies should be given the ________ ventilation pressure needed to raise heart rate to target levels.

Answer 5

Lowest

Question 6

Most neonates respond reasonably to pressure between 20-25cm H2O. While _______ is a reasonable max level for term neonates. But for preterm infants it may be best to cap the pressure off at ____

Answer 6

40 Cm h2o, 30 cm h2o

Question 7

Excessive ventilation pressures are potentially harmful. When moving to PPV choose a device that can deliver 5cm H2O PEEP. Such as ___ & ____

Answer 7

T piece resuscitator & flow inflating bags

Question 8

Neonates born <35 weeks genstation should receive _______% oxygen initially, titrated to age appropriate Sp02 levels.

Answer 8

21-30%

Question 9

If the neonate is intubated and heart rate has stabilized, administer ______ to very preterm babies (<26 week) or premature babies who are in respiratory distress unless it would be harmful or tools unavailable. Surfactant should be administered by an ________ provider

Answer 9

Surfactant, experienced

Question 10

Neonates born at <32 week gestation are at risk for

Answer 10

Neurological injury related to intracranial hemorrhage

Question 11

IV fluid should be given to preterm babies over a period of ____ min rather than IV push. Providers should avoid excessive PPV or CPAP pressures and the ____ position.

Answer 11

5-10 , Trenelenberg (layed on back with feet higher than head)

Question 12

Practice is guided by 4 main principles

Answer 12

Autonomy- patients right to make medical choices, even if they conflict with the providers advise or potential benefit
Beneficence- acting for the benefits of others
Justice-treating all people fairly
Non maleficence- not causing harm

Question 13

If the parents cannot make a decision about whether to start resuscitation, it’s better to start and wait until more info becomes available.

Question 14

When should resuscitation not even be offered?

Answer 14

Anencephaly (underdeveloped brain/skull), lethal genetic abnormality, previabillty (confirmed gestation <22weeks)

Question 15

If there is no detectable heartbeat for the neonate as an apgar score of zero @ _____ min. ____ & ____ can be stopped.

Answer 15

20, PPV, Chest compressions

Question 16

Rather than start resuscitation or after resuscitation has been deemed a fail, providers can provide ____.

Providers and family should ask these questions:

Answer 16

Palliative care (hospice)

Is the intervention likely to succeed?
What are the risks of intervention?
What are the risks of withholding intervention?
Will the intervention likely extend life? By how long?
Is the intervention painful or distressing?
What were the nearest quality of life be with or without the intervention?