Neonatal Resus

Question 1

Define

Answer 1

RCOG define the need for Neonatal Resus as the failure to initiate and sustain breathing at birth or the failure to adapt to cardiopulmonary circulation from the placenta.

Question 2

Incidence

Answer 2

WHO (2012) a quarter of neonatal deaths worldwide occurs as a result of birth asphyxia.

Question 3

Risk factors

Answer 3

Preterm
Breech
Maternal infection
Prolonged 1st and 2nd stage of labour due to increased exposure to hypoxia.
Evidence of intrapartum compromise e.g. Meconium liquor, abnormal CTG.
EMCS
Instrumental delivery
Shoulder Dystocia
Cord prolapse/ presentation
Prep resuscitaire if suspicion NNR required.

Question 4

Fetal physiology to withstand hypoxia

Answer 4

The brown fat reserves mean the baby has ability to cope during periods of hypoxia, however IUGR or SGA babies have less Brown fat reserves and therefore cope for a shorter period of time.

Question 5

Stages of hypoxia

Answer 5

• Initial stage of hypoxia, the baby will attempt to breathe.
• continued hypoxia baby loses consciousness.
• Lack of oxygen to neural centres. Primary apnoea, no respiratory effort.
• HR decreases. Reduced perfusion of vital organs.
• Release of lactic acid in the anaerobic respiration
• Agonal gasps may occur
• Gasps fade, terminal apnoea.
• Acidosis worsens leading to HIE and impaired cardiac functioning.
• Hypoxia continues HR falls, and this can lead to death (20 minutes for healthy term baby)

Question 6

Initial management

Answer 6

Note time of birth
Allow 1 minute of tactile stimulation and drying but if concerns e.g. pale, poor tone etc. clamp and cut the cord and move to resuscitaire.
Note 1 minute APGAR.

Question 7

Management

Answer 7

NMC etc. Call for help 2222 Neonatal Emergency. SBAR
SOAPS. Closed loop.
Explain to parents.
Dry baby and swap towel for a dry one, leaving chest exposed.
Consider antenatal drugs e.g. Pethidine > Naloxone.
Maintain temperature a Neutral thermal environment.
Head and neck in neutral position (straight line)
5 inflation breaths, 1-2-3 2-2-3.
Adjust with guedel and or jaw thrust
30 seconds of ventilation breaths
HR< 60 begin compressions.
rate of 90 per minute 1- 2- 3 breath. reevaluate every 30 seconds. >60 continue ventilation breaths.
APGARS @ 5&10

Question 8

Follow up

Answer 8

Cord Gases 
Umbilical catheter -> SAD
SCBU/NICU
Ensure communication with the parents
Document
Datix 
Debrief
After action r/v