Neonatal Resuscitation

Question 1

How does labour help physiological transition post birth?

Answer 1

Labour = baby stressed = up cortiosol = down fluid synthesis

Question 2

Which newborns require resuscitation?

• Assessment of newborn
• Who should/n’t be suctioned

Answer 2

Tone: floppy + extended
Breathing: apnoeic/ not crying/ not gasping
HR: Bradycardia

Question 3

Intrapartum risk factors for premature newborns:

Note on cord clamping

Answer 3

Oxygen toxic to lungs (hyperoxic injury)

Retinopathy if

Question 4

Neonate Resuscitation algorithm

• overview
• airway

Answer 4

OVERVIEW:
Term gestation? Breathing? Tone?
Prevent heat loss, open airway, stimulate (rub)
Bradycardic, gasping apnoeic?
Positive Pressure Ventilation, SpO2 monitoring
Bradycardic
Open airway, reduce leaks, up pressure & oxygen
Bradycardic (HR

Question 5

Neonate Resuscitation algorithm
- positive pressure ventilation
( indication/ neopuff/ significance)

Answer 5

INDICATION: 1 point APGAR score at 1 min = resuscitate

• Appearance: blue/blue extremities/pink (012)
• Pulse: none/100
• Grimace: none/grimace/cough sneeze
• Activity: flaccid/some flexion/ well flexed
• Respiration: absent/weak, irregular/good,crying

NEOPUFF: non invasive using AIR

• flow rate 10L/min
• insp pressure 30mmHg (>36wks)
• good seal, 60 breaths/min [up pressure/use O2 if doesn’t work)

SIGNIFICANCE
- Functional Residual Capacity = most important (related to gas exchange). Want to keep lungs expanded

Question 6

Neonate Resuscitation algorithm

- tracheal intubation (indication/correct use/causes of failure)

Answer 6

INDICATION: gestational age of infant/degree of resp depression/response to mask ventilation (mask ventilation unsuccessful)/baby born without heartbeat.

CORRECT USE SIGNS: color change on CO2 detector/ETT pass larynx/improved SpO2 & HR/Chest rise/breath sounds over both lung fields/no gastric distention w ventilation/vapor condensing on inside of tube

FAILURE DUE TO: Tube in oesophagus/equipment malfunction/pneumothorax/pleural effusion/diaphragmatic hernia

Question 7

Neonate Resuscitation algorithm

- Chest compression (indication/technique/coordination)

Answer 7

COMPRESSION

Indication: HR

Question 8

Neonate Resuscitation algorithm

- Medications and fluids (indication/routes/adrenaline)

Answer 8

MEDS & FLUIDS - rarely used

Indication: HR

Question 9

Neonate Resuscitation algorithm

• Temp
• Equipment
• Initial assessment

Answer 9

TEMP: 26 degrees C, hat on baby, humidify oxygen. Polyethylene sheet for babies

Question 10

Decision to Discontinue resuscitation

Answer 10

Baby has not responded with measurable heart rate after 10 min maximal resuscitation
b/c survival and quality of survival deteriorate by this time

Question 11

After resuscitation

• infant (monitor, document)
• family (resuscitation of baby, disressful for staff)

Answer 11

INFANT:

• monitor (SpO2/HR/RR/cpillary blood gas analysis)
• document (BP, blood glucose level)

FAMILY:

• distressful, counselling
• staff debrief