Neonatal Resuscitation Flashcards
what factors is neonatal survival dependent on
- quality of labor
- optimal resuscitation
what drugs should be kept in a neonatal resuscitation box
- dilute epinephrine
- dilute dextrose
- ceftiofur
- vitamin K
- naloxone
optimal route for neonatal drug administration
IO, IV, IP
do not want SQ or PO (too slow)
what is ceftiofur used for
3rd gen cephalosporin
used for neonatal sepsis
general protocol for NNR
- one person per neonate
- ALL agree on a standard protocol for resuscitation
- surgeon must inform assistants how they will be handing off the fetuses
ABCs of NNR
airway
breathing
circulation
airway for NNR
clear the fetal membranes (amniotic + allantoic)
- keep head DOWN
- use bulb syringe in the nares to suction out fluid
- use Dee Lee respirator into the oropharynx
ALWAYS palpate heart rate while clearing the airways
do NOT swing the neonate
dee lee aspirator
single use tool that allows the assistant to suction fluid out of the neonates airway
has a filter to protect the assistant from contracting disease
breathing for NNR
dry and stimulate respiration by briskly rubbing the neonate with a warm towel
will stimulate respiratory neuroreceptors on the muzzle and thorax to trigger breathing on their own
want neonate to CRY - requires deep breaths
what does lung expansion do in a neonate
releases surfactant for proper alveolar function
what to do if neonate is still not breathing
ventilate using positive pressure ventilation
30 breaths/min at 10 cm H2O pressure
can do on room air or FiO2 of <40-60%
goal is to get the lungs to expand
what does acupuncture do for neonates
acupuncture needle at Go-26 in nasal philtrum stimulates a gasp
circulation in NNR
evaluate MM color
want HR around 200
what is the cause of bradycardia in neonates
myocardial hypoxemia
must improve ventilation to improve myocardial perfusion and HR
- flow by O2 + PPV
what are the most common complications of NNR
- hypothermia
- hypoglycemia
- bradycardia
- premature neonates
hypothermia in neonates
T < 94F
neonates are unable to thermoregulate - if cold, can fail to establish HR and RR
use a warm water bath to raise temperature and monitor HR while warming
goal: 97-98F
hypoglycemia in neonates
BG < 90
neonates are unable to produce their own glucose due to lack of glycogen stores
use 2.5-5% dextrose IV or IO
if not working - consider tube feeding colostrum (gavage)
bradycardia in neonates
HR < 180
step 1: re-clear airway and ventilate (flow by O2 + PPV)
step 2: (if not working) CPR at 1-2 beats/sec while ventilating
step 3: (if not working) epinephrine - NOT atropine bc will not improve oxygenation
what is the biggest complication with premature neonates
lack surfactant
surfactant is not produced until day 62 of gestation (right before birth)
when should NNR be stopped
if >20-30 minutes without resuscitation
post resuscitation care
- umbilical care
- transfer of immunity
- incubation
umbilical care
- clamp umbilicus with mosquito forceps
- trim 0.5-1 cm and dunk with 2% iodine
goal: avoid ascending bacterial infection from umbilicus (omphalitis) –> peritonitis –> hematogenous spread to pneumonia within 2-3 days
transfer of immunity
colostrum (from dam or another dog)
if none available - immune plasma from a healthy, vaccinated dog/cat
- if <8hr since birth: oral
- if >8hr since birth: SQ
incubation
keep warm in safe environment
T 80-90F
list 5 non-drug items in an NNR kit
- dee lee respirator
- face mask
- bulb syringe
- warm towels
- resuscitation box/incubator
what does neonatal bradycardia indicate and what is the first step to treat it
myocardial hypoxemia
treat with ventilation
what are complicating factors resulting in poor response to resuscitation
- hypoglycemia
- hypoxemia
- hypothermia
- prolonged dystocia
