Neonatal Resucitation Flashcards
What is the critical period for physiologic changes in a newborn?
The first several breaths after birth.
What is the main result of lung expansion in a newborn?
Elevation of partial pressure of oxygen (PO2) in alveoli and arterial circulation.
What happens to pulmonary vascular resistance after birth?
It decreases.
What happens to right-to-left shunting through the ductus arteriosus after birth?
It decreases.
What happens to venous return to the left atrium after birth?
It increases.
What is the result of an increase in left atrial pressure after birth?
Cessation of right-to-left shunting through the foramen ovale.
What does adequate systemic arterial oxygenation depend on?
Well-expanded, well-ventilated lungs and adequate circulation.
What is the fetal response to hypoxia?
Becoming apneic.
What is primary apnea?
A brief period of oxygen deprivation leading to apnea, reversible with stimulation and oxygen.
What is secondary apnea?
A prolonged period of oxygen deprivation leading to irregular gasping and apnea.
What percentage of neonates require some assistance at birth for normal transition?
0.1
What percentage of neonates require extensive resuscitation?
Less than 1%.
Name two maternal conditions that increase the risk of high-risk delivery.
Diabetes mellitus, hypertension.
Name two obstetric conditions that increase the risk of high-risk delivery.
Placental anomalies, premature rupture of membranes.
Name two fetal conditions that increase the risk of high-risk delivery.
Prematurity, macrosomia.
What is the first goal of neonatal resuscitation?
Minimizing immediate heat loss.
What is the main method to establish normal respiration and lung expansion?
Clearing the upper airway and using positive pressure ventilation if necessary.
What percentage of newborns need advanced resuscitation?
Less than 1%.
What percentage of newborns need basic resuscitation with bag-mask ventilation?
3-6%.
What percentage of newborns need simple stimulation at birth?
5-10%.
Name two pieces of essential suction equipment needed in the delivery room.
Bulb syringe, mechanical suction with tubing.
What size ET tubes should be prepared for full-term neonates?
3.5 mm.
What medication is used for neonatal resuscitation in cases of severe bradycardia?
Epinephrine.
What is the first step immediately after a baby is born and is crying?
Routine care: drying, clearing secretions, and skin-to-skin contact.
What are the three initial questions to assess the need for neonatal resuscitation?
Is it a term gestation? Does the baby have good muscle tone? Is the baby crying or breathing?
What are the components of the Apgar score?
Heart rate, respiratory effort, muscle tone, reflex irritability, color.
What is the normal Apgar score at 1 minute?
Between 7 and 10.
What Apgar score at 5 minutes requires further evaluation?
6 or less.
What does an Apgar score of 0-3 indicate?
Severe distress requiring immediate resuscitation.
What are the initial steps of resuscitation?
Provide warmth, clear the airway, dry the baby, stimulate breathing.
What is the mnemonic for ventilation corrective steps?
MRSOPA (Mask adjustment, Reposition airway, Suction, Open mouth, Pressure increase, Alternative airway).
When should chest compressions be started in neonatal resuscitation?
If heart rate remains below 60 bpm after 30 seconds of adequate ventilation.
What is the preferred method of chest compressions for neonates?
Two-thumb encircling technique.
What is the compression-to-ventilation ratio in neonatal CPR?
3:1.
How long should chest compressions be given before reassessing heart rate?
45-60 seconds.
What medication is used if heart rate remains below 60 bpm despite ventilation and chest compressions?
Epinephrine.
What is the IV dose of epinephrine in neonatal resuscitation?
0.1 – 0.3 ml/kg of 1:10,000 solution.
What is the recommended volume expander in neonatal shock?
Normal saline or blood products.
What volume of fluid should be given for neonatal shock?
10 mL/kg IV over 5-10 minutes.
What is the indication for endotracheal intubation in neonatal resuscitation?
Ineffective bag-mask ventilation or prolonged need for ventilation.
What is the purpose of delayed cord clamping?
Improves neonatal iron stores and reduces risk of anemia.
When should cord clamping be done in a stable neonate?
At 60 seconds after birth.
When should resuscitation efforts be stopped?
If there is no detectable heartbeat after 10 minutes of resuscitation.
What temperature should be maintained for a newborn during resuscitation?
Between 36.5 - 37.5°C.
What is the most common cause of neonatal cardiac arrest?
Respiratory failure leading to hypoxia.
What is the first-line treatment for apnea in neonates?
Positive pressure ventilation.
What is the preferred oxygen concentration for resuscitation of term neonates?
21% (room air).
What oxygen concentration should be used in preterm neonates?
21-30% oxygen.
What device is used to measure oxygen saturation during resuscitation?
Pulse oximeter.
What is the ideal chest compression depth in neonatal resuscitation?
One-third of the anteroposterior chest diameter.
What should be done if there is persistent hypoxia despite ventilation?
Consider pneumothorax, diaphragmatic hernia, or airway obstruction.
What is the gold standard for confirming endotracheal tube placement?
Capnography (CO2 detection).
What is the main determinant of neonatal resuscitation success?
Adequate lung inflation.
What is the optimal heart rate for a newborn after resuscitation?
Above 100 bpm.
How should persistent bradycardia be managed in a newborn?
Ensure effective ventilation, then consider epinephrine.
What are two causes of poor response to resuscitation?
Hypothermia, metabolic acidosis.
What is the normal respiratory rate in a newborn?
40-60 breaths per minute.
What are two early signs of neonatal distress?
Retractions, nasal flaring.
What does central cyanosis in a newborn indicate?
Hypoxia requiring oxygen therapy.
What does persistent grunting in a newborn suggest?
Respiratory distress syndrome.
What should be done if a newborn has severe respiratory distress?
Provide CPAP or mechanical ventilation.
What is a late sign of neonatal hypoxia?
Bradycardia.
What should be done if a newborn has meconium-stained amniotic fluid?
If non-vigorous, perform endotracheal suctioning before positive pressure ventilation.
What does persistent hypotension in a newborn suggest?
Sepsis or hypovolemia.
What is the most important step in preventing neonatal hypothermia?
Immediate skin-to-skin contact and drying.
What is the significance of a weak cry in a newborn?
Possible respiratory distress or neurological depression.
What is the primary method of neonatal temperature regulation?
Non-shivering thermogenesis via brown fat metabolism.
What are the three key components of neonatal resuscitation?
Ventilation, oxygenation, circulation.
What should be assessed first in a non-crying neonate?
Airway patency and respiratory effort.
What is the first step in neonatal resuscitation?
Drying the baby and providing warmth.
When should an orogastric tube be placed during resuscitation?
If bag-mask ventilation is needed for more than 2 minutes.
What is the most effective way to improve neonatal oxygenation?
Providing adequate ventilation.
What is the leading cause of neonatal death worldwide?
Birth asphyxia.
What is the role of sodium bicarbonate in neonatal resuscitation?
Used only for severe metabolic acidosis.
What does poor muscle tone in a newborn suggest?
Neurological impairment or hypoxia.
What is the most common metabolic abnormality in neonatal shock?
Hypoglycemia.
