Neonatal resuscitation

Question 1

Initial assessment/mx of newborn

Answer 1

A. Term gestation, breathing/crying, good tone?

• If yes (5):
  1. Stay with mother
  2. Provide warmth
  3. Clear airway if necessary
  4. Dry
  5. Ongoing evaluation
• If no (4):
  1. Warm
  2. Clear airway if necessary
  3. Dry
  4. Stimulate

B. HR below 100, gasping or apnoea?

• If yes:
  1. PPV/CPAP. A+B in resuscitation. Intubate if no chest rise
  2. SpO2 monitoring
• If no, routine care

C. If HR below 60:

1. Consider intubation
2. Chest compressions, coordinate with PPV

D. If HR continues to stay below 60:
1. IV epinephrine

Question 2

Neonatal resuscitation - A

Answer 2

A - airway

1. Position the head - neutral position if 1y
2. Open airway - head tilt and chin lift, or jaw thrust
3. Use oropharyngeal airway if required

Question 3

Neonatal resuscitation - B

Answer 3

A. If respiration is adequate, administer oxygen via facial mask at 10L/min (neonates?)

B. If child not breathing, commence artificial ventilation

1. Infant up to 2y = 500mL bag
2. Select appropriate sized mask
3. O2 flow rate 10-15L/min + attachment of reservoir assembly
4. Brief suction of mouth with yankeur sucker under direct vision
5. Ventilate to have normal chest rise and fall

C. If no chest rise - intubate
- Newborn tube size = 3.0mm, length at lip = 8.5cm

Question 4

Neonatal resuscitation - C (external cardiac compression)

Answer 4

Commence if no pulse or HR

Question 5

Treatable causes of cardiac arrest

Answer 5

1. Hypoxaemia
2. Hypovolaemia
3. Hypo/hyperthermia
4. Hypo/hyperkalaemia
5. Hydrogen ions (acidosis)
6. Tamponade
7. Tension pneumothorax
8. Toxins/poisons/drugs
9. Thrombosis
10. Trauma