neonatal resuscitation week 1

Question 1

Where does resuscitation start?

Answer 1

in utero

Question 2

Baseline heart rate is _____ and a decrease may indicate _______.

Answer 2

Baseline heart rate is normally 120-160 bpm and a decrease may indicate asphyxia

Question 3

Is variability normal?

Answer 3

Yes

The absence of short and long term variability may indicate fetal distress!!!

Question 4

Short term variability

Answer 4

3-6 bpm; CNS depressants reduce this short-term variability

Question 5

Long term variability

Answer 5

Characterized by periodic accelerations correlating with fetal movements normally 15-40 accelerations per hour. Decreases seen with fetal sleep.

Question 6

Early decelerations

Answer 6

Vagal response to head compression, not associated with distress.

Question 7

Late decelerations

Answer 7

Uteroplacental insufficiency. Decreased O2 supply, combined with lack of short-term variability is ominous for fetal distress.

Question 8

Variable decelerations

Answer 8

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.

Question 9

Where can you get fetal blood sampling from?

Answer 9

Can be obtained via scalp puncture after membranes ruptured.

Question 10

Normal neonate ABG values

Answer 10

pH 7.25-7.35 normal

7.20-7.25 is borderline

below 7.20 may be associated with neonatal depression

Question 11

Fetal Scalp Blood Sample Analysis

Answer 11

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

Question 12

What is the goal of fetal treatment?

Answer 12

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.

Question 13

Methods for neonatal assessment

Answer 13

Fetal Heart Rate Monitoring
Apgar scores
Fetal cord pH
CPR

Question 14

APGAR scores

Answer 14

Question 15

Who is primarily responsible for the care of the neonate?

Answer 15

The neonatal care team

Question 16

Anesthesia’s primary responsibility is the ____

Answer 16

Mother! Anesthesia is focused on Mom

If the mother is stable, assistance can however be given to the neonatal team.

Question 17

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 _____

Answer 17

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

Question 18

What should the pulse be?

Answer 18

Over 100

Question 19

When do you start chest compressions?

Answer 19

If the HR is below 60, OR 60-80 and not rising, start compressions (120 bpm) and intubate.

Question 20

How is the correct size ETT indicated?

Answer 20

By a small leak at 20cm H20

Question 21

ETT sizes

Answer 21

<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”

Question 22

What do you give for a low BP?

Answer 22

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.

Question 23

Meds indicated if heart rate remains ____ bpm with adequate ventilation with 100% O2, and chest compressions for ______.

Answer 23

Meds indicated if heart rate remains <60 bpm with adequate ventilation with 100% O2, and chest compressions for 30 seconds.

Question 24

Drug Therapy - epi

Answer 24

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

Question 25

Drug therapy - naloxone

Answer 25

0.1 mg/kg IV or ETT, or 0.2 mg/kg IM to antagonize respiratory effects of narcotics given during labor.

Question 26

Drug therapy - bicarbonate

Answer 26

Sodium Bicarbonate: 2 mEq/kg IV, slowly over 2+ minutes, for acidosis.

1mcg/kg for acidosis babies

Question 27

Increased doses are typically recommended for ETT route in ________ resuscitation, but NOT recommended for _________ resuscitation

Answer 27

Increased doses are typically recommended for ETT route in pediatric resuscitation, but NOT recommended for neonatal resuscitation