Neonatal resuscitation Flashcards
What are the three fetal shunts in utero?
Ductus venosus-In the fetus, the ductus venosus shunts a portion of umbilical vein blood flow directly to the inferior vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver.
Foramen Ovale
Ductus arteriosus
Blood from placenta travels to the baby through: ___ and then it splits and what happens/
Umbilical vein
Then it splits-half bypasses the liver and goes to vena cava and then heart. The other half goes to the liver
When newborns are born, what does inflation of the lungs cause as far as resistance and blood flow?
inflation of the lungs reduces the resistance to blood flow through the lungs-resulting in increased blood flow from the pulmonary arteries, decreased PVR.
Risk factors for fetal distress and associated need for fetal resuscitation:
Previous still birth C section Substance abuse GA for delivery HTN DM
Fetal scalp pH of ____ is considered abnormal and indicates the need for immediate delivery
less than 7.20=immediate delivery
APGAR Score. Break it down (you know you love it! Sike-you don’t love it, but if you just get this down now, you never have to even think about it!!!!!)
Appearance (color) (pink/acrocyanosis/pale-blue all over)
Pulse 0, <100, >100,
Grimace (How the baby responds to stimulation-No response, grimace, cry/movement)
Activity- flaccid, some flexion, legs and arms flexed/active motion
Respirations (Absent, slow/irregular, good/crying)
Measured at 1 and 5 min
0, 1, 2
What equipment do you need for neonatal resuscitation?
suction
Laryngoscope (miller 0 and 1), ETT 2.5-4.0 with stylet
oral airways, face masks
Warmer and stethoscope
What is the initial treatment of all infants?
Warm and dry the infant
Aspirate mouth, pharynx and nose with catheter.
Stimulate infant by slapping soles of feet or rubbing the back
As per the neonatal resuscitation algorithm-if the baby is breathing, and HR is greater than 100, then what?
What if the baby is apneic or has HR less than 100?
What about when the HR goes down to less than 60? And after that intervention if HR is still less than 60, what do you do?
How much time do you give all of these interventions?
Observational care
If apneic or HR less than 100, or if persistent cyanosis, then provide PPV of 30-40 bpm. If after this, HR less than 100 and pt ventilating and pink then give post resuscitation care
Less than 60-PPV and chest compressions at a rate of 100/min. If after that-HR less than 60-administer epinephrine and/or volume
Give each of these interventions 30 sec
If oropharyngeal suction reveals meconium or thick meconium stained mucus-what do you do?
suction via an ETT before lungs are inflated-within 1-2 minutes of delivery
How much sodium bicarb do you give to infants?
Its not recommended during brief CPR, but if its prolonged in face of documented acidosis with adequate ventilation and perfusion, 4.2% sodium bicarbonate may be infused to a dose of 2 mEq/kg via an umbilical catheter
Naloxone in infants: Dose? How can it be given? Do you give it to infants of opioid addicted moms?
0.01 mg/kg. Can be given IV, IM, and SQ or via ETT
You do NOT give to infants who have addicted moms for fear of precipitating w/drawal
Epinephrine dosing in infants. Which concentration? what’s the dose and how can it be given? When would you give it? and how often can it be repeated?
1 : 10,000 concentration
Dose: 0.01 mg/kg IV or 0.1 mg/kg via ETT
It can be given via IV or ETT or tx of asystole or persistent bradycardia despite 30 seconds of effective ventilation and chest compressions
it can be repeated every 3-5 min as needed
Infant dosing of Atropine:
Which ways can it be given?
0.02 mg/kg IV
0.03 mg/kg via ETT
To treat bradycardia
Infant dosing of calcium gluconate
100 mg/kg infused over 5-10 min to treat low cardiac output
