Neonatal Resuscitation Flashcards
What is the required rapid initial evaluation for all newborns
Term?
Tone?
Breathing or Crying?
Next step if newborn baby is not term, has poor tone or is not breathing or crying?
Brought to radiant warmer for the initial steps of newborn care
What are the five initial steps of newborn care
provide warmth position the head and neck clear secretions dry stimulate
After initial steps of newborn care (warmth, position, secretions, dry, stimulate), what are further decisions based on?
Breathing and heart rate
At what point is a pulse oximeter or electronic cardiac (ECG) monitor be placed on a newborn baby?
If heart rate cannot be determined by listening with a stethoscope and baby is not vigorous
What should be used to confirm you perception of persistent central cyanosis, if you are giving supplemental oxygen to an newborn baby?
Target oxygen saturation table to guide oxygen therapy NOT the appearance of cyanosis
When is CPAP helpful in a newborn baby?
When breathing and heart rate is at least 100 beats/min, but respirations are labored or the oxygen saturations remains below the target.
After completing the initial steps, under what circumstances is positive-pressure ventilation indicated
Not breathing OR Gasping OR <100 beats/min OR oxygen not at target with free flow air
Initial oxygen percent for baby on PPV equal to or greater than 35 weeks gestation
21%
Initial oxygen percent for baby on PPV less than 35 weeks gestation
21-30%
Ventilation rate for PPV for newborn
40-60 breaths per minute
Initial ventilation pressure for PPV of a newborn
20-25 cm H2O
Most important indicator of successful PPV is
a rising heart rate
When to check heart rate after starting PPV in a newborn
15 seconds
When are ventilation corrective steps started in a newborn
If heart rate does not increase after 15 seconds of PPV and no chest movement
What are the ventilation corrective steps if heart rate does not increase after 15 seconds of PPV and no chest movement for a newborn
MR. SOPA
M: Mask adjustment
R: Reposition the head
S: Suction mouth and nose
O: Open the mouth
P: Pressure increase
A: Alternative airway
What is the pressure increase in ventilation corrective steps for a newborn with no increase in HR after PPV
5-10 cm H2O increments to maximum of 40
When can PPV be discontinued in a newborn (reducing rate and pressure)
HR continuously above 100 with spontaneous breathing
Use CPAP or free-flow air to maintain oxygen after if needed
When is orogastric tube used with newborn on continuous CPAP or PPV?
after 10 minutes of use
Appropriate laryngoscope blade for a term newborn is size
No. 1
Appropriate laryngoscope blade for a preterm newborn is size
No. 0
How to determine endotracheal tube insertion depth (cm)
NTL (distance from nasal septum to ear tragus) + 1 cm or gestational age (add decimal)
When are chest compression indicated in a newborn
HR remains < 60 despite 30 seconds of PPV, but if chest is not moving with PPV don’t start compression, focus on effective ventilation
Compression to breaths ratio for newborn resuscitation
3 compression to 1 breath
Rhythm: “one-and-two-and-three-and-breath-and”
When to discontinue compressions during resuscitation of a newborn
If HR is > 60, but continue breathing
When is a newborn given epinephrine with resuscitation
HR < 60 after
- At least 30 sec successful PPV
- And another 60 seconds chest compressions with PPV (100% O2)
Newborn epinephrine concentration for resuscitation
0.1 mg/mL
Newborn epinephrine intravenous or intraosseous dosage for resuscitation
0.1 - 0.3 mL/kg may repeat every 3-5 minutes
Newborn epinephrine endotracheal dosage for resuscitation
0.5 - 1.0 mL/kg
Volume expansion recommendations for newborn resuscitation
NS or type-O Rh-negative blood
10 ml/kg over 5-10 minutes
Post-resuscitation care of a newborn infant, need what type of close monitoring
Respiratory effort Oxygenation Blood pressure Blood glucose Electrolytes Urine output Neurologic status Temperature
Where on newborn baby is pulse oximeter placed
right hand
Type of bag that do not require a compressed gas source
Self-inflating bags
Type of bag that cannot be used to administer free-flow oxygen reliably through the mask
Self-inflating bags
The type of bag that cannot be used to administer CPAP to a spontaneously breathing baby
Self-inflating bags
Type of breather that require a compressed gas source
Flow-inflating bags and T-piece resuscitator
Type of bag that must have a tight seal to inflate
Flow-inflating bags
Type of bags that use a flow-control valve to regulate the peak inspiratory pressure (PIP) and positive-end expiratory pressure (PEEP)
Flow-inflating bags
Type of device that can be used to administer free-flow oxygen through the mask
Flow-inflating bags and T-piece resuscitators
What type of breathing devices be used for newborns for administration of CPAP to a spontaneously breathing baby
Flow-inflating bags
For babies weighting less than 1,000 g, the endotracheal tube diameter size should be
2.5 mm
Suspect what if a baby fails to improve despite resuscitative measures or suddenly develops severe respiratory distress
Pneumothorax
Suspect what if a newborn has respiratory distress and generalized edema (hydrops fetalis)
Pleural effusion
Robin sequence
abnormalities such as small lower jaw (micrognathia), a tongue that is place further bak than normal (glossoptosis), and blockage (obstruction) of the airways
Respiratory distress associated with the Robin sequence can be improved by
Placing the baby prone and inserting small endotracheal tube (2.5 mm) into the nose so the tip is in the pharynx
If a small endotracheal tube does not improve respiratory distress of a newborn with Robin sequence, what is next step
A laryngeal mask may provide a lifesaving airway. (endotracheal intubation is frequently difficult)
How to improve respiratory distress associated with bilateral choanal atresia
Inserting modified feeding nipple or pacifier with the end cut off into the baby’s mouth, an endotracheal tube into the mouth with the tip in the posterior pharynx, or an oral (Guedel) airway
If a congenital diaphragmatic hernia is suspected for a delivery, what should be avoided following delivery
Avoid prolonged PPV with a face mask
If a congenital diaphragmatic hernia is suspected for a delivery, what is first step after delivery
Quickly intubate the trachea in the delivery room and insert an orogastric tube with suction to decompress the stomach and intestines
Potential benefits of delayed cord clamping for preterm newborns include
Decreased mortality Higher blood pressure and blood volume Less need for blood transfusion after birth Fewer brain hemorrhages Lower risk of necrotizing enterocolitis
Indications for volume expansion for newborn after resuscitative efforts that included intubation, chest compression, and IV epinephrine
persistently low heart rate that does not respond to previous mentioned things
After chest compression with coordinated ventilations are started in a newborn, the heart rate should be assessed (time)
After 60 seconds
When is heart rate assessed again after epinephrine administration in a newborn
1 minute
