Neonatal resuscitation

Question 1

Determinants of anticipation of resuscitation

Answer 1

Was baby delivered at term?
Is baby crying or breathing?
Does baby have good muscle tone?

Question 2

Prevailing room temperature for resuscitation

Answer 2

Greater or equal to 26C

Question 3

How many cot sheets needed

Answer 3

at least 3

Question 4

Apgar score done at which time intervals

Answer 4

1st and 5th mins

Question 5

Apgar score

• Excellent
• Moderate
• Severe

Answer 5

• Excellent - 7-10
• Moderate 4 - 6
• Severe 0-3

Question 6

Significance of golden minute

Answer 6

Baby should be breathing by the end of the 1st minute of liffe

Question 7

Order of suctioning of mouth and nose

Answer 7

Suction mouth before nose

Question 8

Is suctioning routine

Answer 8

NO

Question 9

If secretions are a lot, to which direction do you tilt the baby

Answer 9

to the right

Question 10

Significance of CE grip

Answer 10

C grip - BVM mask

E grip - maintains sniffing position

Question 11

Position of Middle and last two fingers in the E grip

Answer 11

middle- chin

last 2 - along jaw bone

Question 12

What ideal respiratory rate of a new born does one seek to achieve during the resuscitation

Answer 12

40 - 60 cycles per min

Question 13

When to start chest compression

Answer 13

when pulse rate is less than or equal to 60bpm

Question 14

Best way to provide extra warmth for resuscitation besides wrapping and drying

Answer 14

via the radiant warmer

Question 15

Significance of AGPAR score

Answer 15

Although the APGAR score is not used as a decision making tool, it can be of value in assessing the progress of the resuscitation.

Question 16

Indications for providing positive pressure ventilation

Answer 16

apnea, gasping and heart rate < 100bpm

Question 17

Reasons chest may not rise with ventilation include:

Answer 17

wrong ambu bag placement

components of ambu bag are not properly connected, splinting of diaphragm by air leakage into stomach, obstructed airway

Question 18

Ways of improving ventilation

Answer 18

Mask readjustment

Reposition airway

Suction mouth and nose

Open mouth

Pressure increase

Alternative airway

Question 19

Compression to respiraration ratio

Answer 19

3: 1

90 compressions and 30 ventilations

120 activities in one minute

Question 20

When to discontinue chest compression

Answer 20

Above 60 bpm

Question 21

Where exactly on the chest are the compressions done?

Answer 21

Performed halfway at the lower third of sternum or moving 1cm below an imaginary line drawn through the nipples.

Question 22

When to start adminstration of drugs

Answer 22

If heart rate remains < 60bpm in spite of 1 minute of effective/efficient PPV combined with chest compressions

Question 23

Dose of adrenaline given

Answer 23

Administer 0.1-0.3 ml/kg of adrenaline (1 in 10,000)

Question 24

Mode of adminstration of adrenaline

Answer 24

Given IV, preferably via umbilical catheter; can also be given via endotracheal tube.

Question 25

When to repeat dose of adrenaline

Answer 25

Dose can be repeated every 3 to 5 minutes if heart rate is still less than 60bpm.

Question 26

Indication of normal saline and dose

Answer 26

Indicated for new-borns not responding to resuscitation and showing signs similar to shock.

10ml/kg over 5-10 mins

Question 27

When dextrose is given

Answer 27

10% dextrose can be given in cases of hypoglycemia (blood glucose < 2.6mmol/L).
2ml/kg IV followed by continuous infusion.
Reduces risk of adverse neurologic outcomes.

Question 28

When should resuscitation be stopped?

Answer 28

Resuscitation should only be stopped when the neonate is not breathing and the heart rate is undetectable for at least 10 minutes