neonatal resus

Question 1

initial action

Answer 1

Place the baby skin to skin with the mother.
* Provide external stimulation while drying the baby.
* Maximise the external temperature and place a hat on the baby if possible.
* Continue to provide stimulation via rubbing/drying if breathing or activity is abnormal.
* Establish continual heart rate and SpO2 monitoring if breathing or activity remain abnormal.

Question 2

If breathing is adequate and the heart rate is greater than or equal to 100/minute

Answer 2

• Do not provide ventilation.
• Clamp and cut the cord at 2-3 minutes.
• Move to the appropriate section if there is a sustained change in heart rate.
• Administer oxygen only if required to maintain a normal SpO2.

Question 3

If breathing is inadequate or the heart rate is 60-100/minute

Answer 3

• Clamp and cut the cord immediately if this is required to enable ventilation.
• Ventilate at a rate of 60/minute, using PEEP set to 5 cmH2O, initially without added oxygen.
• Continue to ventilate and add oxygen at 10 litres/minute if the heart rate fails to rise above 100/minute after two minutes.
• Move to the appropriate section if there is a sustained change in heart rate.

Question 4

If the heart rate is less than 60/minute

Answer 4

• Clamp and cut the cord immediately if this is required to enable CPR.
• Start CPR at a ratio of 3:1.
• Focus on ventilation with PEEP set to 5 cmH2O and added oxygen at 10 litres/ minute.
• Place an LMA.
• Consider placing an ETT.
• Gain IV access.* Administer adrenaline IV every four minutes:
  a) 0.01 mg (0.1 ml of 1:10,000) for gestation less than or equal to 26 weeks.
  b) 0.025 mg (0.25 ml of 1:10,000) for gestation 27-37 weeks.
  c) 0.05 mg (0.5 ml of 1:10,000) for gestation greater than or equal to 38 weeks.
• Move to the appropriate section if there is a sustained change in heart rate.

Question 5

Normal SpO2 post birth:

Answer 5

ū 60-70% at 1 minute.
ū 65-85% at 2 minutes.
ū 70-90% at 3 minutes.
ū 75-90% at 4 minutes.
ū 80-90% at 5 minutes.
ū 85-90% at 10 minutes.
ū 90-95% at more than 10 minutes.

Question 6

Clamping and cutting the umbilical cord

Answer 6

• Delaying clamping and cutting the cord until 2-3 minutes after birth appears to improve the outcome for the baby.
• There is no urgency to clamp and cut the cord provided neither the baby nor the mother are requiring resuscitation.
• Clamp and cut the cord at least 5 cm from the baby as this facilitates access to the cord vessels for later cannulation if required.

Question 7

neonate is not hypoglycaemic unless the glucose concentration is less than

Answer 7

2.5 mmol/litre.