neonatal resus - amboss Flashcards
early term
37+0 - 38+6 weeks
full term
39+0 - 40+6 weeks
late term
41+0 - 41+6 weeks
post term
after 42 weeks
preterm
live birth before 36+6 weeks
which babies require neonatal resus
infants who are born prematurely, lack muscle otne, are not breathing or crying
appropriate for gestational age infant (AGA)
10th - 90th percentile for gestational age
small for gestational age (SGA)
birth weight <10th percentile for gestational age
large for gestational age (LGA)
birth weight >90th percentile
low birth weight
birth weight <2500g regardless of the gestational age
occurs in early term or IUGR
associated with increased mortality, especially due to SIDS
very low birth weight
1000g-1499g regardless of gestational age
extrememly low birth weight
<1000g regardless of gestational age
immidiate care of the newborn
- 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
APGAR stands for
appearance, pulse, grimace, activity, respirations
five components of apgar score
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
classification of apgar scores
reassuring 7-10
moderately abnormal 4-6
low 0-3
pulse heart rate apgar score measurement
none = 0
BPM<100 = 1
BPM>100 = 2
calculation of the apgar scores table
factors causing a delivery to be high risk
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
delayed cord clamping
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
if the neonate requires intervention
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
management of secretions
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
if you use suction, what order do you sunction in
mouth before nose
m before n
what should the suction setting be
100mmHg
over vigourous suctioning will cause
a vagal response
neonate will become apnoiec and bradycardic and may require full resus
should you always use suction
generally not required unless there are obvious signs of obstruction
for infants exposed to meconium stained fluid
suction
no routine direct laryngoscopy
circulation
if there is effective breathing, the HR will generally be above 100
auscultate and tap out the beat
pulse oximetry
should you do direct routine laryngoscopy for mec stained liquor exposure
not recommended
if PPV is not effective
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)
recommended O2 setting
FiO2 21% for term or near teerm infants
for <35 weeks do FiO2 blended gas up to 30%
settings for PPV
T piece device or self inflating bag
PIP: 30 for term, 25 for preterm
PEEP: 5-8 for term, 5 for preterm
ventilation technique
place neonate supine with head neutral or in sniffing position
open mouth
position mask and create seal
ventilate at a rate of 40-60
signs of adequate ventilation
HR improves and increases to above 100bpm
symmetrical rise and fall of the chest with each inflation
increasing O2 sats
at what point would you start compressions
when HR is <60 despite 30 seconds of PPV
ratio of compressions
three chest compressions to one breath
key considerations in compressions
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
compression technique
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
medications and fluids in resus
if HR<60
administer adrenaline
repeat every 3-5 minutes if the HR remains <60
how to administer adrenaline
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
post resus care
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
