Neonatal Resuscitation Flashcards
Effect of hypoxia on the neonate?
Hypoxia is central to neonatal resuscitation. Normal labour and birth leads to hypoxia. When contractions happen, the placenta is unable to carry out normal gaseous exchange, leading to hypoxia. Extended hypoxia will lead to anaerobic respiration and a subsequent drop in the fetal heart rate (bradycardia). Further hypoxia will lead to reduced consciousness and a drop in respiratory effort, in turn worsening hypoxia. Extended hypoxia to the brain leads to hypoxic-ischaemic encephalopathy (HIE), with potentially life-long consequences in the form of cerebral palsy.
Other than hypoxia, what are other issues in neonatal resus?
Babies have a large surface area to weight ratio, and get cold very easily
Babies are born wet, so they lose heat rapidly
Babies that are born through meconium may have this in their mouth or airway
Basic principles of neonatal resuscitation
- Warm The Baby -
Get the baby dry as quickly as possible. Vigorous drying also helps stimulate breathing.
Keep the baby warm with warm delivery rooms and management under a heat lamp
Babies under 28 weeks are placed in a plastic bag while still wet and managed under a heat lamp
- Calculate the APGAR Score -
This is done at 1, 5 and 10 minutes whilst resuscitation continues
This is used as an indicator of the progress over the first minutes after birth
It helps guide neonatal resuscitation efforts
- Stimulate Breathing -
For example by drying vigorously with a towel
Place the baby’s head in a neutral position to keep airway open. A towel under the shoulders can help keep it neutral.
If gasping or unable to breathe, check for airway obstruction (i.e. meconium) and consider aspiration under direct visualisation
- Inflation Breaths -
Inflation breaths are given when the neonate is gasping or not breathing despite adequate initial simulation.
Two cycles of 5 inflation breaths (lasting 3 seconds each) can be given to stimulate breathing and heart rate
If there is no response and the heart rate is low, 30 seconds of ventilation breaths can be used
If there is still no response, chest compressions can be used, coordinated with the ventilation breaths
When performing inflation breaths, air should be used in term/near term babies, and a mix of air and oxygen should be used in pre-term babies. Aim for a gradual rise in oxygen saturations, not exceeding 95%.
- Chest Compressions -
Start chest compressions if heart rate remains below 60 bpm despite resuscitation and inflation breaths
Chest compressions are performed at a 3:1 ratio with ventilation breaths
- Severe Situations -
Time is precious during neonatal resuscitation. Prolonged hypoxia increases the risk of hypoxic-ischaemic encephalopathy (HIE). In severe situations, IV drugs and intubation should be considered. Babies near/at term that have possible HIE may benefit from therapeutic hypothermia with active cooling.
What is APGAR score?
The APGAR score is measured out of 10. The lowest score is 0 and the highest is 10.
Delayed umbilical cord clamping?
In neonates requiring resus?
After birth there is still a significant volume of fetal blood in the placenta. Delayed clamping of the umbilical cord provides time for this blood to enter the circulation of the baby. This is known as placental transfusion. Recent evidence indicates that in healthy babies, delaying cord clamping leads to improved haemoglobin, iron stores and blood pressure and a reduction in intraventricular haemorrhage and necrotising enterocolitis. The only apparent negative effect is an increase in neonatal jaundice, potentially requiring more phototherapy.
Current guidelines from the resuscitation council UK state that uncompromised neonates should have a delay of at least one minute in the clamping of the umbilical cord following birth.
Neonates that require neonatal resuscitation should have their umbilical cord clamped sooner to prevent delays in getting the baby to the resuscitation team. The priority will be resuscitation rather than delayed clamping.
