Neonatal Resuscitation

Question 1

What is a birth <20 weeks?

Answer 1

• miscarriage

Question 2

When is a baby considered viable?

Answer 2

> 24 weeks

Question 3

How many weeks is considered term?

Answer 3

37-42 weeks

Question 4

What pathophysiological changes occur in a newborn immediately post birth

Oxygenation and circulation

Answer 4

• the pressure created by crying forces lung liquid out of the alveoli and is replaced with air over several breaths
• With increased blood flow to the lungs and increased in oxygenation of the blood, pulmonary pressure changes and the foetal ducts close
• breathing is the single most important thing a baby can to do to start this series of events
• The entry of air into the alveoli with crying and breathing improves oxygenation of the pulmonary vascular bed, decreasing PVR and increasing pulmonary blood flow. The increase in pulmonary blood flow raises left atrial pressures more than right atrial pressures, closing the foramen ovale. Removal of the low-resistance placental bed from the systemic circulation at birth increases systemic vascular resistance. As PVR decreases to less than SVR, flow reverses across the ductus. Oxygen-induced vasodilation and lung expansion decrease PVR to approximately half of SVR within a few minutes after birth. Over the first few hours after birth, the ductus arteriosus closes, largely in response to the increase in oxygen tension, and with this the normal postnatal circulatory pattern is established.

Question 5

Draw the APGAR score

Answer 5

Question 6

What is a satisfactor APGAR score?

Answer 6

7-10

Question 7

What APGAR score indicates moderate respiratory depression and may need respiratory support

Answer 7

4-6

Question 8

What APGAR score indicates full resuscitation?

Answer 8

0-3

Question 9

When do you perform an APGAR score?

Answer 9

at 1 minute
5 minutes
and every 5 mins after that until 20 mins

Question 10

What care do you need to provide to the newborn thats breathing adequately and good muscle tone

Answer 10

• continue to dry (especially the head)
• maintain warm (skin to skin, blankets, hat)
• routine suction is not recommended
• monitor HR (auscultation), breathing, tone, colour
• if vitals deteriorate or airway is obstructed manage as per newborn resus

Question 11

How can you keep the baby warm?

Answer 11

• dry the newborn well, especially head
• place skin to skin contact with mother
• cover them both with warm towels
• cover the newborns head with corner of warm towel or hat
• make the interior of the ambulance as warm as possible
• avoid exposure to draughts
• minimise the transit time in the ambulance

Question 12

In what time frame do you cut the cord?

Answer 12

• there is no rush to cut the cord

Question 13

What is the normal tidal volume of a neonate?

Answer 13

16-35mls (5-10mls/kg)

Question 14

How do you suction a neonate?

Answer 14

• wipe mouth and nose first
• use 10-12 french catheter, insert no deeper than 5cm
• keep pressures <100mmHg and only suction for <5 seconds when withdrawing the suction catheter

Question 15

What are some complications of suctioning newborns?

Answer 15

• trauma to the airway
• apnoea
• bradycardia

Question 16

Where do you apply the pulse oximetry on a newborn? and why?

Answer 16

• Right wrist
• the R) hand is supplied from the aorta before mixing has occured at the level of the ductus arteriosus (pre-ductal). These vessels are perfusing the head/neck reflect arterial oxygen saturation before mixing with pulmonary blood at the level of the ductus arteriosus and therefore higher
• in utero the foetus has mixed circulation where arterial and venous blood are mixed. Normal birth trigger the transition process whereby the 3 foetal shunts begin to close and normal postnatal circulation commences. Up to 72 hours to be complete. In utero foetal saturations are normal 40-50%. after the birth the saturations increase >90% but it takes up to 10 mintues. As long as the HR >100 bom and the newborn is breathing, it does not require supplemental O2

Question 17

What are the target saturations post birth?

Answer 17

Question 18

How do you perform CPR to a neonate?

Answer 18

• 3:1 ratio, 90 compressions, 30 ventilations (120 events per minute)
• Compressions: 1/3 depth chest, 2 thumbs preferred
• Ventilations - use BVM. OPA not routinely required
• Defibrillation - paed pads (anterior/posterior) 4 joules/kg
• Unlikely to be required. Often PEA/asystole

Question 19

What is the max O2 used in newborns

Answer 19

Max 5L/min
even in an arrest