Neonatal resuscitation

Question 1

what is the best indicator of hypoxia?

Answer 1

bradycardia

Question 2

what factors prediscpose newborns to hypothermia

Answer 2

1. low fat stores
2. can’t shiver
3. large surface area to volume ratio
4. often wet
5. cool environment
6. high metabolic rate

Question 3

What are the signs described by the APGAR score and at what time are the measurements taken

Answer 3

Appearance, Pulse, Grimace, Activity, Respirations

1 and 5 min

HR, RR, Tone, reflex irritability, colour
score 0-2 for each

Question 4

What is hypoglycemia defined as in neonates

Answer 4

GT 2.5kg glucose LT 2.2mmol/L

LT 2.5 kg glucose

Question 5

When should you perform tracheal suction

Answer 5

Non vigorous infant with meconium:

HR

Question 6

How is meconium aspirated from the trachea

Answer 6

ETT intubation
apply suction/meconium aspirator at 10mmHg
Withdraw ETT tube as you suction
Repeat until clear

Question 7

Which neonates should not be resuscitated

Answer 7

GA LT 23wks confirmed
LT 400gm
anencephaly
confirmed chromosomal abN not compatible with life (Trisomy 13,18)

Question 8

What equip is required for neonatal resus

Answer 8

• PPE
• Radiant warmer
• Blankets
• Laryngoscope (00, 0, 1)
• ET Tubes (2.5, 3.0, 3.5, 4 – with stylets)
• Bulb syringe
• Suction catheters
• Meconium aspirator
• CO2 detector
• Self-inflating bags (450 and 750mL)
• Masks (Prem, NB, and infant sizes)
• Scissors/tape
• Umbilical catheters (3.5 and 5)
• Hemostats, sterile drapes, scalpel
  Drugs (Epi 0.01mg/kg, Narcan 0.1mg/kg, Dextrose D10W, Ventolin/Bicarb/Insulin/CaCl, Abx)

Question 9

How long is an umbillical vein patent

Answer 9

1-2 wks of life

Question 10

What is normal feeding for a neonate?

Answer 10

Day 1-4: 60,80,100, 120cc/kg/d

1 wk breast milk 150cc/kg/d or 100cal/kg/d

Question 11

DDx of sick neonate

Answer 11

THE MISFITS
- T – Trauma (Acidental & NAT)
- H – Heart disease, Hypovolemia; Hypoxia
- E – Endocrine
o Congenital adrenal hyperplasia
o Thyrotoxicosis
- M – Metabolic (electrolyte disturbance)
- I – Inborn errors of metabolism
- S – Sepsis (meningitis, pneumonia, UTI)
- F – Formula mishaps (under / overdiluted)
- I – Intestinal catastrophes (volvulus, intussusception, NEC, toxic megacolon, pyloric stenosis)
- T – Toxins / poisons
- S – Seizures

Question 12

Outline approach to congenital adrenal hypoplasia

Answer 12

treat shock with IV fluid bolus 20-40cckg
draw serum cortisol and ACTH
give epi 0.01mg/kg/min if not responsive
treat hyperK if present with CaCl 20mg/kg or insulin 0.1U/kg + glucose +/- HCO3 1ml/kg
treat hypoglycemia: bolus dextrose D10 at 5ml/kg then maintenace D5NS at 2x maintenance