New born life support

Question 1

How many new born babies start breathing spontaneously without intervention?

Answer 1

85%

Question 2

What percentage of new born babies respond after drying, stimulation and airway opening manoeuvres?

Answer 2

10%

Question 3

What percentage of babies must receive positive pressure ventilation on birth?

Answer 3

Aprox 5%

Question 4

What percentage of infants receive chest compressions at birth?

Answer 4

0.3%

Question 5

How do infants cope with the hypoxic event that is child birth?

Answer 5

• Higher affinity to O2 and a different Hb
• A new born’s heart can continue beating for 20 mins or more despite anoxia
• The new born brain can withstand anoxia longer than an adult’s

Question 6

How quickly do new borns start to breathe after birth?

Answer 6

Most newborn babies will take a first breath within 10-30 secs of birth and establish effective breathing within 90-120 sec

Question 7

The first breath is stimulated by:

Answer 7

• Mild hypoxia of labour
• Increased arterial CO2 levels and lower pH stimulate central chemoreceptors
• Meeting the air (chemoreceptors in the throat)

Question 8

What does a well baby look like?

Answer 8

• Born blue but becomes centrally pink during the first 90 seconds or so after birth
• Has good tone (not floppy)
• Cries within a few seconds of birth
• Good heart rate of 100-160bpm

Question 9

What does a less well baby look

Answer 9

• Blue at birth and doesn’t pink up quickly
• Reduced tone (a bit floppy)
• Inadequate or absent respirations
• Slow heart rate (<100 bpm)
• Observe closely, stimulate and be ready to act

Question 10

What does an unwell baby look like?

Answer 10

• Born pale
• Floppy
• Not breathing
• Heart rate <60/min or undetectable
• Commence resuscitative measures urgently

Question 11

What equipment do you need for NLS?

Answer 11

• Maternity pack
• Towels
• Hat
• Stethoscope
• BVM
• Laryngoscope
• OPA
• Tongue depressor
• i-Gel
• Thermometer
• SPO2 monitor
• Oxygen tank

Question 12

What is the standard approach to NLS?

Answer 12

1. Dry and cover the baby skin-to-skin with mum, cord intact, stimulating baby if necessary
2. Assess
3. Airway
4. Breathing
5. Circulation (chest compressions)

Question 13

How quickly can heat loss occur in the pre-hospital setting for new borns?

Answer 13

Heat loss can be very rapid, with a drop of 0.1–0.3°C for each minute the baby is exposed

Question 14

How does low admission temperature affect mortality in low birth weight babies?

Answer 14

Mortality increases by 28% for every 1°C below 36.5°C at admission

Question 15

What complications can hypothermia and cold stress lead to in newborns

Answer 15

Hypoxia, acidosis, impaired surfactant synthesis, and coagulation defects

Question 16

What must you continuously assess during NLS?

Answer 16

• Colour
• Tone
• Breathing
• Heart rate

Question 17

What is the order of aeration / ventilation that must be performed during NLS?

Answer 17

• Always start with 5 inflation breaths, must see chest rise and fall before continuing
• Continue with ventilation breaths, 15 over 30 seconds (ideally with oxygen)
• As long as there is chest rise and fall but assessment shows little improvement, start compressions to ventilations 3:1 over 30 seconds before reassessment