Neonatal Resuscitation Flashcards
In the Helping Babies Breath (HBB) Algorithm, what are the 5 steps to be completed in the 1st minute of life (if required)?
- Warm and dry the baby
- Airway positioning +- suction
- Active stimulation
- Clamp and cut the cord
- Start ventilation with bag-valve mask
Ideally, if you arrive pre-delivery, what should you do to prepare? (3 items)
- Check your equipment and tools
- Brief the team
- Communicate with the mother (if appropriate)
Describe your process of checking a resuscitaire ( 11 items)
- Switch on machine + heat/light source
- Check towels or cloths available
- Check mask -size appropriate for the patient
- Set inflation pressures - appropriate for GA
- Check functioning bag-valve-mask
- Check oxygen source
- Check suction
- Stethoscope
- Cord clamp
- Scissors or scalpel
- Hat
Baby arrives - what do you do? (3 items)
- Start the clock
- Dry and stimulate with warm towels/cloths
- Assess colour, tone, breathing and heart rate
For low resource settings - what do you do next if the baby is floppy and not breathing (3 items)
- Position the airway (neutral)
- Site the face mask
- Deliver ventilation breaths
How long do you deliver these ventilation breaths, before you reassess?
30 seconds
How will you know if your ventilation has been effective?
- Rise and fall of the chest - chest expansion
What will you do if you did not see the chest rise? (3 items)
- Reposition the airway
- Reposition the mask
- Check BVM connection
What will you do if after 30 seconds you still did not see the chest rise? (3 items)
- Trial 2 person technique
- Consider airway adjunct
- Consider an increase in inflation pressures
What is the ratio of chest compressions to ventilation breaths for neonatal resuscitation?
3: 1
3 compressions to 1 breath
What is the dose of adrenaline mg/kg in neonatal resuscitation?
0.01mg/kg
What is the strength of adrenaline used in neonatal resuscitation?
1:10,000 = 1mg/1ml
How do you create a dilute solution of adrenaline for neonatal resuscitation?
1ml of (1mg/ml) Adrenaline mixed with 9ml 0.9% sodium chloride = 10ml solution at 0.1mg/ml strength
Remember the neonatal dosing is 0.01mg/kg
With a 0.1mg/ml solution of Adrenaline and a 3kg infant - how much Adrenaline should you use (in ml) for neonatal resuscitation?
0.01 x 3 = 0.03mg dose
1ml =0.1mg
0.1ml = 0.01mg
therefore
0.3ml = 0.03mg
In a low resource setting (MSF guideline) when should you consider stopping neonatal resuscitation? (2 items)
- No HR after 10 mins
2. No spontaneous breathing after 20 mins (even IF heart rate is present)
What 3 things should you MEASURE in a post-resuscitation scenario?
- Temperature
- Glucose
- Oxygen saturations (if able)
What should you EXAMINE for post-resuscitation?
Neonatal danger signs - systems review style ABC
What should you RECORD following a resuscitation? (4 items)
- What you needed to do
- Retrospective APGAR score
- Follow up plan - admit and/or observe
- Communication with family
Who should you COMMUNICATE with post-resuscitation? (3 items)
- Mother (+ family)
- NICU team (if needed)
- Obstetric team/midwives
What are the 5 components of the APGAR score?
- Colour
- Irritability
- Tone
- Breathing
- Heart rate
What is the maximum number of points for each component on the APGAR score?
2 points
Each component score 0-2
A maximum score of 10
At what intervals is the APGAR score ideally performed?
1 and 5 minutes after birth
At 1 minute of life an infant has an APGAR score of 0-4, what does that suggest?
Birth Asphyxia (HIE risk)
At 1 minute of life an infant has an APGAR score of 5-7, what does that suggest?
Difficult adaptation
At 1 minute of life an infant has an APGAR score of 8-10, what does that suggest?
Good adaptation
At 5 minutes of life what APGAR score would suggest a birth asphyxia risk?
A score of 0-6
At 5 minutes of life what APGAR score would suggest a difficult adaptation?
A score of 7-8
At 5 minutes of life what APGAR score would suggest a good adaptation?
A score of 8-10
What is the threshold of significant concern for an APGAR score at 1 and 5 minutes, respectively? (2 items)
A score of less than or equal to 4 at 1 min
A score of less than or equal to 6 at 5 mins
What does the APGAR score NOT tell you?
It does not have prognostic value for an individual infant beyond the time of birth
Referring to ANTEPARTUM MATERNAL risk factors for neonatal resuscitation - What age extremes will increase risk?
Mother < 15 years
Mother > 35 years (considered old in childbearing terms)
Referring to ANTEPARTUM MATERNAL risk factors for neonatal resuscitation - what 5 maternal features would raise your concern?
- Multiple pregnancies (twins/triplets)
- Maternal infection
- Bleeding in second/third trimester
- Maternal medications
- Previous loss of an infant in the prenatal, intrapartum or neonatal periods
Referring to INTRAPARTUM maternal risk factors for neonatal resuscitation - What types of delivery are increased risk (3 items)
- Emergency cesarean section (LSCS)
- Under general anaesthesia
- Instrumental delivery
What does a prolonged second stage mean?
The second stage of labour lasting > 2 hours
Note: The second stage = fully dilated cervix + baby to descend in vagina.
Prolonged second stage = risk factor for neonatal resuscitation
Labour lasting greater than … hours (overall) is a higher risk for neonatal resuscitation.
24 hours
How is prolonged rupture of membranes defined?
A pre-labour rupture of membranes of > 18 hours (without commencement of delivery)
Note: Distinct from Pre-term premature rupture of membranes
PROM is a risk factor for neonatal resuscitation
List 3 INTRAPARTUM Infant factors that increase the risk of neonatal resuscitation.
- Macrosomia (large baby)
- Fetal bradycardia
- Meconium stained liquor (significant not light)
What does SIGNIFICANT meconium-stained liquor signify?
The fetus passes meconium into the amniotic fluid during the antepartum or intrapartum period.
Significant = Dark green or black fluid that is thick +_ particulate matter
Aetiology unclear - thought to signify a response to some form of stressor
Increased risk for fetal outcomes (short and long term) + of neonatal resuscitation
What is INSIGNIFICANT meconium-stained liquor?
Liquor that is stained yellow or pale green, without particulate matter - considered lower risk
List 4 INTRAPARTUM Maternal factors that increase the risk of neonatal resuscitation.
- Placenta Praevia
- Umbilical cord prolapse
- Maternal interuterine infection (chorioamnionitis)
- Heavy bleeding (other cause)
What are acceptable neonatal oxygen saturations at 2 minutes of life?
60%
What are acceptable neonatal oxygen saturations at 3 minutes of life?
70%
What are acceptable neonatal oxygen saturations at 4 minutes of life?
80%
What are acceptable neonatal oxygen saturations at 5 minutes of life?
85%
What are acceptable neonatal oxygen saturations at 10 minutes of life?
90%
What % of infants require help to breathe at birth?
10%
100/1000
What % of infants require cardiac massage at birth?
<1%
<10/1000
What is the goal for temperature regulation of a neonate during resuscitation?
Maintain a temperature of 36.5-37.5 degrees
What could you do to maintain the temperature of a premature infant of 32 weeks GA or less (4 items)?
- Thermal mattress
- Plastic bag up to the neck
- Hat
- Warmed resuscitation gases (if possible)
What should the temperature of the delivery room be for an infant 32 weeks and under?
23-25 degrees C
Give 2 reasons why deep suctioning of the airway is NOT advised.
- Vagal nerve stimulation –> Bradycardia
2. Possible trauma of oropharynx
