Neonatal Resuscitation Flashcards
What is the first decision point for neonatal resuscitation?
Immediately after birth assess: Term? Tone? Breathing or Crying?
If all good, then routine care and stay with mother.
If not all good, then progress down the algorithm.
Child is born at 37 weeks, appears to have good tone, and has a strong cry, what is the next step?
Suction if needed, position airway, warm and dry, keep with mother, continue to evaluate and monitor.
Child is born at 35 weeks, appears lethargic and is not breathing well immediately after birth. What is the next step? What is the next decision point?
Child does not stay with mother immediately after birth.
Warm, dry, stimulate, position airway, suction and assess for response
Assess for breathing (apnea or gasping) and HR>100
After birth, child requires initial interventions due to poor tone and respiratory effort. On reassessment the child has labored breathing and some cyanosis. What is the next step?
Reposition airway, suction if needed, place on SpO2 monitor, give O2 if needed, consider CPAP
After birth, child requires initial interventions due to poor tone and respiratory effort. On reassessment the child is apneic or gasping and has a HR of 80. What is the next step?
Start PPV, place on monitor, give O2 if needed
Monitor for HR dropping below 100 to determine if additional steps are needed
Initial resuscitation was started on an infant after birth. They are on monitor and PPV and the airway has been suctioned and positioned appropriately. What is the most important sign to monitor and what is the next step if abnormal?
Should watch the HR as this is the most sensitive indicator of oxygenation in a newborn. If drops below 100 despite all interventions, make sure there is chest movement, and consider ETT or LMA
If the HR ever drops below 60, what are the next steps?
Intubate if not already done Chest compressions ECG monitor 100% O2 IV access
Child has required intubation, CPR due to HR <60, after these interventions are started, what is next?
Monitor HR for improvement >60
If no improvement, give epinephrine 0.01mg/kg
Consider hypovolemia and give bolus of NS 10mL/Kg
Also consider pneumothorax
What glucose level should be treated and how?
Glucose <40 should be treated with D10 5mL/Kg
What team members are needed for a neonatal resuscitation?
Recorder, Tech, Nurse, RT, Physician
How should chest compressions be coordinated with breathing during CPR?
3:1 compressions to breaths
One and Two and Three and breath…
When giving PPV to a neonate, what rate should the breaths be given at?
60/min
Breath two three, Breath two three..
What are the expected O2 sats of a newborn over the first 10 minutes of life?
> 60% at one minute and increase by 5% per minute until >85% at 10 minutes
Never below 60%
What is one critical thing to do right at the TIME of birth to help guide the rest of the resuscitation?
Have someone start the timer at the time of birth
What lab value should always be checked at the beginning of a resuscitation?
Blood glucose
How is umbilical catheter placed?
Tie umbilical tape at the base
Clean with iodine
Cut with scalpel 1–2 cm above the abdomen
Pull apart with hemostats
Place catheter (which has already been prepared with saline flush and stop cock) into the umbilical vein
Advance catheter only 3–4 cm (too deep is bad)
Aspirate blood
Tighten umbilical tape
How can pneumothorax be diagnosed without CXR?
Transillumination of the chest wall
What is treatment for pneumothorax?
Aspiration with needle and stop-cock at the 2/3 mid-clavicular line
How is NRP different from PALS and ACLS?
ABC not CAB
Pause for ventilations even after definitive airway
3:1 ratio compressions to breaths
Breathing is the priority
What are maternal red flags suggesting possible need for resuscitation?
Infection, GDM (big baby or hypoglycemic), Pre eclampsia or eclampsia, poor pre-natal care, received Mg (causes poor tone and poor respiratory effort)
When should resuscitation not be attempted?
Fundal height below umbilicus, <22weeks, Biparietal diameter less than 5cm, eyes fused closed
What is the first assessment?
Tone, Term, Breathing
Consider no resuscitation if no tone, very premie, or no breathing
What are guidelines for suctioning?
No deep suctioning and only if indicated
What are the first signs that resuscitation is needed?
Apnea, gasping, or HR < 100
What should be done if patient is apneaic, gasping, or HR < 100?
PPV with RA if at term and with O2 if premie, rate 40-60/min
Pulse ox and ECG monitor
Consider intubation if prolonged
What to remember about supplemental O2?
Aggressive O2 is harmful!
When should a resuscitation be terminated due to very poor prognosis for neuro outcome?
Pulseless x 10 minutes
HR < 60 for 20 minutes
What are benefits of delayed cord clamping?
Delaying 30–60 seconds decreases ICH, NEC, need for transfusion, and many other benefits
When should initial respiratory support include O2 >21%?
Premies less than 37 weeks, might start at 30%
What is a priority in kids <32 weeks?
Temperature management!
Consider placing in plastic and not drying
Who gets surfactant?
Kids less than 24 weeks or if intubated due to respiratory distress
If <500g then likely less than 24 weeks
What is the best survival rate at 22 weeks?
2–3% at best
What is the initial setting for PPV?
20 PIP, 5 PEEP
Who can get an LMA?
> 2kg or >34 weeks
What ETT sizes in preterm kids?
Term: 3.5 uncuffed
28–38 wks 3.0 uncuffed
<28 wks 2.5 uncuffed
All kids get cuffed except for neonates!
Take age in weeks and round down for approximate size
Post resuscitative considerations
Avoid hyperthermia, may get cooled in PICU, but not if transferring
Avoid hypoxia, hypotension, hypoglycemia
What is the mnemonic for airway management if not improving with initial interventions?
MR SOPA Mask Reposition Suction Open Mouth Pressure increase to cause chest rise Airway control (intubation)
