Neonatal Resuscitation Flashcards
What is the main aim of newborn resuscitation?
To inflate the lungs with air or oxygen so oxygenated blood can be pumped to and from the heart and start recovery.
Why do all neonates experience a degree of hypoxia during labour?
Respiratory exchange may be interrupted for as long as 50-75 seconds during contractions.
What is breathing initiated through a combination of?
Decreased O2 conc
Increases CO2 conc
Decreased blood ph
Stimulation of the respiratory centre in the medulla
Compression of the chest during birth.
What is the mechanism of decreased O2 conc?
• Baby comes out.
• Placenta removed from circulation (Clamp).
• Lungs take in air.
• Whartons jelly contracts around 3 vessels, due to temperature falling.
• Clamps down on umbilical arteries and vein.
• No blood flowing through umbilical vein.
• Dron vent a and win superior candie tontait ail lot endead sinto er and the
pulmonary artery from right ventricle.
• Overall Oxygen saturation of fetal blood in reduced (MacDonald and Johnson, 2017).
What are the respiratory differences between adults and newborns?
Size
Thermal control:strong association between hypothermia and mortality/morbility
Condition of heart- unless a cardiac defect is present, the heart is in a good condition and unaffected by age/diet etc.
Content of lungs- fluid filled. 35mls expelled via oropharynx during birth but 70ml rapidly absorbed into the blood stream and lymphatics once breathing established
What is the necessary assessment at birth?
Start the clock and note time of birth
Keep baby in skin to skin and cover in warm, dry blankets. Apply
Where no concerns are identified, delayed cord clamping of at least 1 minute is recommended
Help?
What is the APGAR score and what does each letter stand for?
Used to give an indication of the health of the baby at 1 and 5 mins (and at 10 is required
Appearance
Pulse
Grimace
Activity
Respirations
What is airway obstruction usually due to?
Due to loss of pharyngeal tone not foreign material in the airway Position not sunction!
How do you choose the size of a mask?
To cover nose and mouth but not extend over the edge of the chin or encroach on the orbits.
What are the 3 ps of applying a neonate mask?
Position- align, roll, check
Pressure- balance between finger and thumb
Pull-lift/pull the jaw upwards into the mask.
What should you reassess after rhesus?
Colour, tone, breathing, heart rate
What to check if chest is not moving?
Check mask, head and jaw position
2 person support
Consider suction, Guedes airway
Repeat inflation breaths
Consider increasing inflation pressure.
When should ventilation breaths be given?
Lungs inflated with inflation breaths, heart rate >100bpm but not breathing OR
Lungs inflated with inflation breaths but heart rate remains slow and not breathing
Ventilation breaths at a rate of 30 breaths per minute
Reassess after 30 seconds.
When should chest compressions be started?
Only when you are sure that the lungs have been aerated successfully.
What do chest compressions do?
Move oxygenated blood from the lungs back to the heart.
