neonatal resus - amboss

Question 1

early term

Answer 1

37+0 - 38+6 weeks

Question 2

full term

Answer 2

39+0 - 40+6 weeks

Question 3

late term

Answer 3

41+0 - 41+6 weeks

Question 4

post term

Answer 4

after 42 weeks

Question 5

preterm

Answer 5

live birth before 36+6 weeks

Question 6

which babies require neonatal resus

Answer 6

infants who are born prematurely, lack muscle otne, are not breathing or crying

Question 7

appropriate for gestational age infant (AGA)

Answer 7

10th - 90th percentile for gestational age

Question 8

small for gestational age (SGA)

Answer 8

birth weight <10th percentile for gestational age

Question 9

large for gestational age (LGA)

Answer 9

birth weight >90th percentile

Question 10

low birth weight

Answer 10

birth weight <2500g regardless of the gestational age
occurs in early term or IUGR
associated with increased mortality, especially due to SIDS

Question 11

very low birth weight

Answer 11

1000g-1499g regardless of gestational age

Question 12

extrememly low birth weight

Answer 12

<1000g regardless of gestational age

Question 13

immidiate care of the newborn

Answer 13

• clear away secretions around nose and mouth, use suction only if necessary
• dry and stimulate the newborn
• provide warmth
• skin to skin contact and initiation of breastfeeding
• clamp and cut umbilical cord
• apgar score assessment at 1 and 5 minutes after birth
  begin resus if onset of respiratioon has not yet occured within 30-60 seconds

Question 14

APGAR stands for

Answer 14

appearance, pulse, grimace, activity, respirations

Question 15

five components of apgar score

Answer 15

skin colour
heart rate
reflex irritability to tactile stimulation
muscle tone
respiratory effort

each component given 0-2 points, depending on the stutus of the newborn

Question 16

classification of apgar scores

Answer 16

reassuring 7-10
moderately abnormal 4-6
low 0-3

Question 17

pulse heart rate apgar score measurement

Answer 17

none = 0
BPM<100 = 1
BPM>100 = 2

Question 18

calculation of the apgar scores table

Answer 18

Question 19

factors causing a delivery to be high risk

Answer 19

maternal factors = advacnes maternal age, very young, diabetes, hytertension, substance use, previous fetal loss, bleeding in second or third trimester
fetal factors = prematurity, post maturity, congenital abnormality, multiple gestations
complications = placental anomalies,
prolonged rupture of membranes
oligo/polyhydramnios, breech, chorioamnionitis, meconium stained amniotic fluid, abnormal fetal heart rate, delivery with forceps/vacuum/caesarean

Question 20

delayed cord clamping

Answer 20

For infants who are vigorous or deemed not to require immediate resus at birth:
>34 weeks gestation deferred clamping of the cord >60 seconds
<34 weeks defer cord clamping at least 30 seconds

Question 21

if the neonate requires intervention

Answer 21

lack of tone, not crying and no chest wall movement or gasping
then clamp the cord and transfer to the resus cot
warmth, dry, position head in neutral position
stimulate by gently rubbing the back, trunk and extremities
if breathing is not established by 1 minute, if HR is below 100 or if they are gaasping or apnoeic then proceed to PPV

Question 22

management of secretions

Answer 22

mouth and pharyngal suction is generally not required unless there are obvious signs of obstruction
gently suction the airway of secretions for no longer than 5 seconds

Question 23

if you use suction, what order do you sunction in

Answer 23

mouth before nose
m before n

Question 24

what should the suction setting be

Answer 24

100mmHg

Question 25

over vigourous suctioning will cause

Answer 25

a vagal response
neonate will become apnoiec and bradycardic and may require full resus

Question 26

should you always use suction

Answer 26

generally not required unless there are obvious signs of obstruction

Question 27

for infants exposed to meconium stained fluid

Answer 27

suction
no routine direct laryngoscopy

Question 28

circulation

Answer 28

if there is effective breathing, the HR will generally be above 100
auscultate and tap out the beat
pulse oximetry

Question 29

should you do direct routine laryngoscopy for mec stained liquor exposure

Answer 29

not recommended

Question 30

if PPV is not effective

Answer 30

M - mask adjustment/reapply
R - reposition airway - adjust head, neutral or slightly extended

(retry PPV and assess chest wall movement)

S - suction mouth then nose
O - open mouth and lift jaw forward

(retry PPV and assess chest wall movement)

P - pressure increase, consider increasing ventilation pressures
A - alternative airway, insert subglottic airway or endotrachial tube

(retry PPV, assess chest wall movement and breath sounds)

Question 31

recommended O2 setting

Answer 31

FiO2 21% for term or near teerm infants
for <35 weeks do FiO2 blended gas up to 30%

Question 32

settings for PPV

Answer 32

T piece device or self inflating bag
PIP: 30 for term, 25 for preterm
PEEP: 5-8 for term, 5 for preterm

Question 33

ventilation technique

Answer 33

place neonate supine with head neutral or in sniffing position
open mouth
position mask and create seal
ventilate at a rate of 40-60

Question 34

signs of adequate ventilation

Answer 34

HR improves and increases to above 100bpm
symmetrical rise and fall of the chest with each inflation
increasing O2 sats

Question 35

at what point would you start compressions

Answer 35

when HR is <60 despite 30 seconds of PPV

Question 36

ratio of compressions

Answer 36

three chest compressions to one breath

Question 37

key considerations in compressions

Answer 37

increase oxygen via the blender to 100%, wean as soon as possible following HR recovery
once compressions have commenced preparation should begin for intubation (if not already performed), vascular access and adrenaline administration
ECG monitoring should be applied if chest compressions are being used

Question 38

compression technique

Answer 38

hands centered above the xiphisternum and below the nipples
the chest should be allowed to fully expnd between comprssions but the rescuers hands/fingers should not leave the chest
the two thumb technique achieves better peak systolic and coronary perfusion pressure, provides more consistent compressions over long periods of time and it less tiring for the rescuer

Question 39

medications and fluids in resus

Answer 39

if HR<60
administer adrenaline
repeat every 3-5 minutes if the HR remains <60

Question 40

how to administer adrenaline

Answer 40

preferred route is umbilical venous cetheter followed by aa saline flush
otherwise use intraosseous or IV
you can use endotrachial if there is a delay in inserting a UVC or getting access, but its is likely that a higher dose will be required to achieve similar blood levels

Question 41

post resus care

Answer 41

temperature management
cardiorespiratory management: if they have required intubation, they should not be extubated until a thorough assessment can confirm they are not at risk of requiring re-intubation
BGL: neonates that have required resus are at increased risk of hypoglycaemia
antibiotics if there is infection