Neonatology - Resuscitation Flashcards
Why does normal labour and birth lead to hypoxia?
When contractions happen, placenta unable to carry out normal gas exchange
What does extended hypoxia in the new-born lead to?
Anaerobic respiration and bradycardia
Further hypoxia
- Reduced consciousness
- Reduced respiratory effort
Extended
- Hypoxia to brain causing hypoxic-ischaemic encephalopathy (HIE)
What does hypoxic-ischaemic encephalopathy lead to?
Cerebral palsy
What issues must be considered in neonatal resuscitation?
- Babies get cold very easily due to large SA:weight
- Born wet, lose heat rapidly
- Babies that are born through meconium can have it in their mouth or airway
What are the principles of neonatal resuscitation?
- Warm the baby
- Calculate APGAR
- Stimulate breathing
- Inflation breaths
- Chest compressions
How is the baby warmed?
- Dry baby quickly, vigorous drying helps stimulate breathing
- Keep baby warm with warm delivery room and heat lamps
- Babies under 28 weeks put in plastic bag while wet and put under heat lamp
When is that APGAR scored calculated during resuscitation?
1,5 and 10 minutes while resuscitation continues
Good indicator of progress of the baby
How is breathing stimulated?
- Drying vigorously with a towel
- Head in neutral position to keep airway open
- If gasping check for airway obstruction e.g. meconium and consider aspiration
How can you help keep the baby’s head in a neutral position?
Towel under the shoulders can help keep it neutral
When are inflation breaths used?
Neonate gasping or not breathing despite stimulation
- 2x 5 inflation breaths
- 30 seconds of ventilation breaths (if no response and low heart rate)
- If unresponsive, chest compressions
Air used in term or near term babies
Air and oxygen in pre-term babies
Do not exceed 95% oxygen sats
When are chest compressions used?
Heart rate below 60 despite resuscitation and inflation breaths
3:1 ratio with ventilation breaths
In possible hypoxic-ischaemic encephalopathy what can be done?
Therapeutic hypothermia with active cooling
Complete the table for APGAR
What happens in delayed umbilical cord clamping?
Significant volume of foetal blood in the placenta
Delayed clamping gives time for blood to enter baby circulation
This is called placental transfusion
What can placental transfusion lead to?
In healthy neonates
Improved
- Hb
- Iron stores
- Blood pressure
Reduction in :
- Intraventricular haemorrhage
- Necrotising enterocolitis
Can increase neonatal jaundice leading to more phototherapy
