neonatal resuscitation week 1 Flashcards
Where does resuscitation start?
in utero
Baseline heart rate is _____ and a decrease may indicate _______.
Baseline heart rate is normally 120-160 bpm and a decrease may indicate asphyxia
Is variability normal?
Yes
The absence of short and long term variability may indicate fetal distress!!!
Short term variability
3-6 bpm; CNS depressants reduce this short-term variability
Long term variability
Characterized by periodic accelerations correlating with fetal movements normally 15-40 accelerations per hour. Decreases seen with fetal sleep.
Early decelerations
Vagal response to head compression, not associated with distress.
Late decelerations
Uteroplacental insufficiency. Decreased O2 supply, combined with lack of short-term variability is ominous for fetal distress.
Variable decelerations
Related to cord compression, associated with fetal asphyxia when they are greater than 70 bpm, longer than 60 sec, or occur in a pattern persisting for more than 30 min.
Where can you get fetal blood sampling from?
Can be obtained via scalp puncture after membranes ruptured.
Normal neonate ABG values
pH 7.25-7.35 normal
7.20-7.25 is borderline
below 7.20 may be associated with neonatal depression
Fetal Scalp Blood Sample Analysis
Normal
pH: 7.25-7.35 (mean 7.33)
pCO2: 40-50 mmHg
pO2: 20-30 mmHg
Base: <10
Metabolic Acidosis
pH: <7.25
pCO2: 45-55 mmHg
pO2: <20 mmHg
Base: >10
Respiratory Acidosis
pH: <7.25
pCO2: >50 mmHg
pO2: Varies
Base: <10
What is the goal of fetal treatment?
Goal should be to restore uteroplacental circulation
Avoid and treat aortocaval compression.
Correct hypotension.
Correct hypoxia.
Failure to remedy the situation calls for immediate delivery.
Methods for neonatal assessment
Fetal Heart Rate Monitoring
Apgar scores
Fetal cord pH
CPR
APGAR scores
Who is primarily responsible for the care of the neonate?
The neonatal care team
Anesthesia’s primary responsibility is the ____
Mother! Anesthesia is focused on Mom
If the mother is stable, assistance can however be given to the neonatal team.
Resp. rate should be ____ per min
Bag mask ____ breaths per min w/ 100% O2
Initial breaths (1-5 roughly) may require ____ cm H2O pressure but after that keep pressure below ____ cm H2O
Gastric decompression often _____
Resp. rate should be 30-60 per min
Bag mask 40-60 breaths per min w/ 100% O2
Initial breaths (1-5 roughly) may require 40 cm H2O pressure but after that keep pressure below 30 cm H2O
Gastric decompression often helpful
What should the pulse be?
Over 100
When do you start chest compressions?
If the HR is below 60, OR 60-80 and not rising, start compressions (120 bpm) and intubate.
How is the correct size ETT indicated?
By a small leak at 20cm H20
ETT sizes
<28 weeks, <1kg = 2.5 (6-7cm depth)
28-34 weeks, 1-2 kg = 3.0 (7-8)
34-38 weeks, 2-3 kg = 3.5 (8-9)
> 38 weeks, > 3 kg, 3.5-4 (9-10)
‘typically a 3.0 cuffed for baby at 38 weeks”
What do you give for a low BP?
10 ml/kg of LR
“10-40 cc/kg is normal”
Normal BP variable (50/25 for 1-2 kg infant vs. 70/40 for >3kg infant)
Rule out hypoglycemia, hypermagnesemia or hypocalcemia as causes of hypotension.
Meds indicated if heart rate remains ____ bpm with adequate ventilation with 100% O2, and chest compressions for ______.
Meds indicated if heart rate remains <60 bpm with adequate ventilation with 100% O2, and chest compressions for 30 seconds.
Drug Therapy - epi
Epinephrine: 0.01-0.03 mg/kg for bradycardia or asystole despite quality chest compressions.
may administer in 1 ml of saline via ETT.
1mcg/kg of epi is common
Drug therapy - naloxone
0.1 mg/kg IV or ETT, or 0.2 mg/kg IM to antagonize respiratory effects of narcotics given during labor.
Drug therapy - bicarbonate
Sodium Bicarbonate: 2 mEq/kg IV, slowly over 2+ minutes, for acidosis.
1mcg/kg for acidosis babies
Increased doses are typically recommended for ETT route in ________ resuscitation, but NOT recommended for _________ resuscitation
Increased doses are typically recommended for ETT route in pediatric resuscitation, but NOT recommended for neonatal resuscitation
