Neonatal resuscitation Flashcards
What are 5 stages of newborn resuscitation?
- Dry baby and maintain temperature
- Assess tone, respiratory rate, heart rate, colour
- If gasping or not breathing give 5 inflation breaths with bag valve mask
- Reassess (chest movements)
- If heart rate not improving and <60bpm, start compressions and ventilation breaths at rate of 3:1
What are 4 ways to prevent heat loss from the neonate?
- Protect baby from draught
- Keep delivery room warm
- Drying term baby immediately after delivery, covering the head and body with warm towel to prevent further heat loss
- Place baby on warm surface under radiant warmer, if resuscitation needed
What is the most efective way to keep a preterm baby born before 28wks warm?
cover head and body (apart from face) with a plastic bag before placing under radiant heater (rather than towels)
What are the 4 important things to assess for babies who may need resuscitation?
- Colour - pink/cyanosed/pale
- Tone - floppy = likely to be unconscious
- Breathing - rate, depth, symmetry, grunting, gasping
- Heart rate - best evaluated by auscultating with a stethoscope
What are the 4 groups into which babies can be placed to help determine need for resuscitation?
- Group 1: healthy - vigorous baby, crying, becoming pink, good tone, HR >110
- Group 2: primary apnoea - apnoeic or inadequate breathing, remaining blue, reduced tone, HR >100
- Group 3: terminal apnoea - apnoeic, blue or pale, floppy, HR <100
- Group 4: fresh stillbirth - apnoeic, pale, floppy, no heart rate
What is the management of group 1 neonates?
dry and warm, hand to mother for skin to skin contact
What is the management of group 2 neonates (primary apnoea)?
dry and warm, tactile stimulation, facial oxygen, consider mask ventilation if not improving
What is the management of group 3 neonates (terminal apnoea)?
- Dry and warm
- Mask ventilation
- If no improvement may need intubation, ventilation, and chest compressions if heart rate not improving
What is the management of group 4 nenonates - fresh stillbirth?
full cardiopulmonary resuscitation
What position should the neonatal head be put in for the ‘airway’ stage of ABC and why
neutral position - different from adults due to relatively large occiput of babies, overextension of neck can occlude airway
What are 2 ways to enhance the airway during the A part of ABC assessment in a neonate?
- jaw thrust - but careful not to compress airway under chin
- Guedel of appropriate size (oral airway)
When is the only time suction should be performed to clear the airway?
if there is blood or particulate material in oropharynx
How should suction be performed in the A part of ABC for neonates?
non-aggressive, always under direct vision with laryngoscope
blind suction not helpful, even if meconium-stained liquor
Why must blind suction of the airway be avoided?
can lead to trauma and induce bradycardia or laryngospasm
How do you choose the correct size mask for mask ventilation in ABC for the neonate?
should cover nose and mouth but not extend beyond chin or over orbits
What are 3 situations when mask ventilation may be necessary in a neonate?
- Apnoeic
- Irregular breathing
- Bradycardic
What inflation pressure should the first 5 breaths given to a newborn sustain and for how long should the inflation last? What are these type of breaths called?
approx 30cm of water for term infant, 2-3 seconds = inflation breaths
What is the aim of inflation breaths?
aim is to displace the lung fluid and expand the lungs
if effective, chest wall movement and improvement of heart rate should be seen
If inflation breaths result in rising heart rate but the baby is still not breathing, what is the next step?
ventilate at 30-40 breath/min, maintaining inflation for about 1s for each breath (ventilation breaths)
If there is no improvement following inflation/ ventilation breaths what should be done?
airway should be checked again, help sought, early additional assistance
What is important to remember about the only time chest compressions will be effective?
if the lungs have been successfully inflated
What is the aim of chest compressions in the newborn?
aim to deliver oxygenated blood to the heart allowing circulation to recover
What is the indication for chest compressions in the neonate?
should be done if infant remains bradycardic despite adequate ventilation
What is the compression:ventilation ratio used for neonates?
3:1
How should you arrange your hands for neonatal chest compressions?
both thumbs placed over lower third of sternum, encircling chest with both hands; other fingers lie behind baby supporting the back
What is the appropriate depth of chest compressions in the neonate?
third of anteroposterior diameter, allowing return to relaxed position between compressions
How many compressions and how many breaths should be given per minute in neonatal resuscitation for bradycardia?
90 compressions : 30 breats /min
How often should heart rate be checked during neonatal resuscitation?
every 30s
What is the only situation when drugs are used for neonatal resuscitation?
if adequate ventilation and effective chest compression have failed to increase HR above 60
In the resuscitation situation, how should drugs be delivered to neonates?
via umbilical venous catheter
What are 4 drugs that may be given in neonatal resuscitation?
- Adrenaline
- Sodium bicarbonate - reversing intracardiac acidosis
- Glucose - if hypoglycaemic
- Volume replacement (e.g. 0.9% saline 10ml/kg) - if in shock
Should suctioning be performed if the infant is active, vigorous and crying?
no
When is cord clamping recommended for uncompromised babies?
at least 1 min from complete delivery of infant
What should room temperature be for preterm (<28 weeks) infants?
at least 26 degrees C
What should the blow-off valve on the Resuscitaire be initially set to for pre-term infants?
20-25cm of water (rather than 30cm for term infants)
When should neonates be offered therapeutic cooling?
for infants born at term or near term with evolving moderate to severe hypoxic-ischaemic encephalopathy
