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[2018] PEDYUHH > Neonatology - Neonatal Resuscitation > Flashcards

Neonatology - Neonatal Resuscitation Flashcards

1
Q

Single most important and effective intervention in Neonatal Resuscitation

A

VENTILATION of the Lungs

NRP, 6th ed

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2
Q

Percentage of newborns requiring assistance to begin breathing?

Percentage of newborns requiring resuscitative measures in order to survive?

Percentage w/o having any difficulty transitioning?

A

10%
< 1%
at least 90%

(NRP, 6th ed)

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3
Q

ABCs of Resuscitation

A

Airway - secure position and its clearance
Breathing - stimulate to breathe
Circulation - assess HR and O2 Sats

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4
Q

Important factor to consider when resuscitating

A

Temperature

Maintain at normal range when resuscitating (36.5 - 37.5 deg Celsius). Prevents heat loss.

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5
Q

True or False:

Risk Factor identification during pregnancy and labor can identify all babies requiring resuscitation upon delivery.

A

False

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6
Q

Choose: Always needed? Need less frequently? Rarely Needed?

Warmth

A

Always needed

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7
Q

Choose: Always needed? Need less frequently? Rarely Needed?

Chest compressions

A

Rarely

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8
Q

Choose: Always needed? Need less frequently? Rarely Needed?

Supplemental O2

A

Need less frequently

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9
Q

Choose: Always needed? Need less frequently? Rarely Needed?

clear airway

A

Always

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10
Q

Choose: Always needed? Need less frequently? Rarely Needed?

Drying and Stimulation

A

Always

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11
Q

Choose: Always needed? Need less frequently? Rarely Needed?

Medications

A

Rarely

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12
Q

Choose: Always needed? Need less frequently? Rarely Needed?

Tracheal intubation

A

Need less frequently

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13
Q

Choose: Always needed? Need less frequently? Rarely Needed?

Positive pressure ventilation

A

Need less frequently

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14
Q

Main Difference between Adult and Neonatal Resuscitation?

A

Priority.
Adult: C –> A –> B
Neonates: A –> B –> C

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15
Q

Characteristics of Fetal Lungs

A
  1. expanded in utero
  2. filled with fluid
  3. constricted arterioles sec to low pO2.
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16
Q

3 MAJOR CHANGES that happen to allow the baby to get O2 from the lungs

A
  1. alveolar fluid is absorbed into pulmonary lymphatics and replaced by air
  2. umbilical arteries constrict and then umbilical arteries and veins are closed when the cord is clamped
  3. blood vessels in the lung relax/dilate, decreasing blood flow resistance
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17
Q

2 Main stimuli for pulmonary blood vessels to relax

A
  1. Oxygen

2. Gaseous distention of the lungs

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18
Q

of minutes it takes for a normal newborn to reach an O2 Sat of 90%

A

~10 minutes

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19
Q

of hours it takes for functional closure of PDA

A

12 - 24 hours after birth

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20
Q

How long does it take for the lung vessels to completely relax?

A

Several Months

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21
Q

FIRST clinical sign of FETAL Compromise?

A

Heart Rate Deceleration

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22
Q

Problems that may disrupt normal transitioning

A
  1. Lungs are not filled with air despite adequate respiratory efforts (e.g. meconium aspiration, weak muscles)
  2. expected increase in BP may not occur (e.g. excessive blood loss, neonatal hypoxia and ischemia)
  3. persistent constriction of pulmonary arterioles
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23
Q

2 organs that are prioritized when O2 sats are low

A

Brain and Heart

aka Survival Reflex

24
Q

Clinical Findings of a Compromised Baby

A
  1. depression of respiratory drive from insufficient O2 to CNS
  2. Poor muscle tone - insufficient O2 to brain and muscles
  3. Bradycardia - insufficient O2 to myocardium or brain stem
  4. Tachypnea - sec to failure to absorb fetal lung fluid
  5. Persistent Cyanosis - insufficient O2 in blood
  6. Low BP - insufficient O2 to heart muscle, blood loss
25
Q

First sign seen when a NEWBORN has had some perinatal compromise

A

Cessation of respiratory efforts

26
Q

What is Primary Apnea?

Intervention?

A

Cessation in breathing preceded by a period of rapid breathing. HEART RATE BEGINS TO FALL as the baby enters primary apnea

Do stimulation such as drying or slapping the feet; breathing SHOULD resume

27
Q

What is Secondary Apnea?

Intervention?

A

Cessation in breathing preceded by a brief period of GASPING BREATHS. BLOOD PRESSURE BEGINS TO FALL as the baby enters secondary apnea.

Provide assisted ventilation. Stimulation will no longer work.

28
Q

With effective resuscitation, what VS will show the most abrupt improvement?

A

Heart Rate

29
Q

3 Main questions to ask at the time of birth

A
  1. Is the baby term?
  2. Is he/she crying/breathing?
  3. Does he/she have a good tone? Limp?
30
Q

ALGORITHM QUESTION:

If the answers to all of the 3 main questions are YES, you proceed to Routine Care. What are the components of Routine Care?

A
  1. Provide Warmth (cover the baby + skin to skin contact)
  2. Gently clear the airway as necessary
  3. Dry the baby.
31
Q

ALGORITHM QUESTION:

If any of the 3 main questions is answered with a NO, what is the very first thing that you should do?

A

Bring the kid to the radiant warmer and perform further resuscitation there.

Remember, you should always ensure adequate heat/warmth when resuscitating. Hypothermia can cause apnea and bradycardia.

32
Q

ALGORITHM QUESTION:

What are the INITIAL STEPS OF NEWBORN RESUSCITATION? And how long does this take?

(Legit answers kasi paulit-ulit na ineenumerate ang same components dun sa mga guidelines)

A
  1. Maintain normal body temperature
  2. Position the infant in a SNIFFING POSITION.
  3. Clear secretions as necessary
  4. Dry the Infant.
  5. Stimulate the infant to breathe.

Once should complete these steps within 30 SECONDS. Evaluate the baby after.

33
Q

ALGORITHM QUESTION:

Once the initial steps are done and the airway is secured, what are the two parameters that you need to evaluate in order to proceed to B (Breathing)?

A
  1. Heart Rate (if less than 100 bpm)

AND

  1. Breathing (if the baby is persistently cyanotic or the breathing appears to be labored or the baby is apneic)
34
Q

ALGORITHM QUESTION:

Recommended method of assisting a full term baby’s breathing? pre-term?

A

Do PPV for both.

Use a mask. Secure it on the baby’s face. Apply positive pressure breaths (aka bag)

35
Q

ALGORITHM QUESTION:

When assisting a baby’s breathing, how fast should the RR be?

A

40 - 60 breaths per min.

36
Q

ALGORITHM QUESTION:

When assisting/Once you start assisting a baby’s breathing (PPV, supplemental O2, etc), what should you monitor?

A

Oxygen saturation.
You now monitor 3: HR, Respirations and O2 Saturation.

Always attach a pulse oximeter preductally…so at the right side.

37
Q

ALGORITHM QUESTION:

What are the indications for the use of Pulse Oximetry?

A
  1. When need for resuscitation is anticipated
  2. When PPV is administered
  3. When central cyanosis persists beyond the first 5 - 10 minutes of life
  4. When supplementary O2 is given

2015 AHA Neonatal Resuscitation Guidelines

38
Q

ALGORITHM QUESTION:

How do you assess for the adequacy/effectiveness of ventilation?

When do you assess?

A
  1. Inc in HR to greater than 100 bpm
  2. Slight rise of chest and upper abdomen with each inflation
  3. Improving oxygenation

After about 30 seconds of EFFECTIVE ventilation.

39
Q

ALGORITHM QUESTION:

What is the most recommended PPV Delivery Device? What are the other options?

A

T-Piece device is the preferred

Other options:
Self inflating bag, Flow inflating bag, Face masks

40
Q

ALGORITHM QUESTION:

If T-piece is used as a PPV Delivery Device, what are the settings to be used?

A

Peak Inspiratory Pressure (PIP):
if Term, 30cm H2O
if preTerm, 20 - 25 cm H2O

Positive End Expiratory Pressure:
5 - 8 cm H2O

41
Q

ALGORITHM QUESTION:

There are instances when a trial of CPAP can be used instead of PPV. What are these?

A
  1. Spontaneously breathing newborns who have labored breathing/respiratory distress
  2. Newborns who are breathing but whose saturations are not adequate

2015 AHA Neonatal Resuscitation Guidelines

42
Q

ALGORITHM QUESTION:

When using supplemental oxygen, what is the preductal O2 Saturation target at the 1st minute? 2nd minute? 3rd minute? 4th minute? 5th minute? 10th minute?

A 
1 minute: 60 - 65%
2 minutes: 65 - 70%
3 minutes: 70 - 75%
4 minutes: 75 - 80%
5 minutes: 80 - 85%
10 minutes: 85 - 95%

REDUCE O2 Concentration if saturation reaches 90% while supplemental oxygen is being used

43
Q

ALGORITHM QUESTION:

When do you start supporting circulation?
How do you support the circulation?

A

If the HR is below 60bpm despite adequate ventilation corrective steps.

Start Chest Compressions that are coordinated with PPV. Do endotracheal intubation.

44
Q

ALGORITHM QUESTION:

Chest Compression to Breathing ratio

A

3:1

A total of 90 compressions and 30 breaths in a minute.
OR
120 events per minute.

Reassess every 30 seconds

45
Q

ALGORITHM QUESTION:

2 methods of doing chest compressions?
Which is preferred?

A

2 thumb technique

2 finger technique

46
Q

ALGORITHM QUESTION:

How do you assess for improvement during circulatory support?

A
  1. Audible heart sounds on auscultation
  2. Spontaneous pulsations on oximetry
  3. Rise in Oxygen saturation
  4. Spontaneous movements or breaths
47
Q

ALGORITHM QUESTION:

How do you choose the appropriate ET Tube Size?

A

Internal Diameter:

  1. 5 mm ETT for neonates less than 1 kg
  2. 0 mm ETT for neonates 1 - 2 kg
  3. 5 mm ETT for neonates 2 - 3 kg
  4. 5 - 4.0 mm ETT for neonates greater than 3 kg
48
Q

ALGORITHM QUESTION:

Formula for the level of ET placement

A

ET Level = Weight in kg + 6

49
Q

ALGORITHM QUESTION:

Cadence for PPV vs CAB?

A

PPV Cadence:
Breath-2-3, Breath-2-3

CAB Cadence:
1 and 2 and 3 and Breathe
1 and 2 and 3 and Breathe

50
Q

ALGORITHM QUESTION:

How do you confirm correct ETT positioning? or What are the signs that would tell you that the ETT is placed correctly?

What is the GOLD Standard

A
  1. Chest movement with each inflation
  2. Heart rate increasing above 100 bpm
  3. Improving oxygenation
  4. Visual inspection of ETT passing through the larynx
  5. Misting in the ETT during expiration
  6. Symmetrical breath sounds using a stethoscope
  7. Chest Xray showing proper tube placement

Gold Standard: Capnography, presence of expired CO2

51
Q

ALGORITHM QUESTION:

When do you start giving drugs?
What drug?

A

If HR is still below 60 despite ventilation and compressions.

IV Epinephrine, 1:10,000, 0.01 to 0.03 mg/kg

ET Epinephrine can be used at a dose of 0.05 - 0.1 mg/kg

52
Q

Warming Techniques recommended for VLBW preterm babies

A
  1. Prewarming the delivery room to 26 deg C
  2. Covering the baby in plastic wrapping
  3. Placing the baby on an exothermic mattress
  4. Placing the baby under radiant heat
53
Q

What is the dose for volume administration?

A

10 ml/kg

Do this when blood loss is suspected and when the baby’s HR has not responded adequately to other resuscitative measures

54
Q

Ideal amount of time to finish intubation?

A

should be finished/completed within 20 seconds

55
Q

When do you withhold resuscitation?

A
  1. Extreme prematurity (<23 weeks AOG or <400g birthweight)
  2. Anencephaly
  3. Major Chromosomal Abnormalities (e.g. Trisomy 13)
56
Q

When do you discontinue resuscitative efforts?

A

In a newborn with NO DETECTABLE HR, stop resuscitation if HR remains undetectable for 10 MINUTES.

[2018] PEDYUHH (3 decks)

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