Newborn

Question 1

What are the clinical features which indicate the need for resus in newborns?

Answer 1

1. No signs of life:
   - Limp muscle tone
   - Slow (<30 / min) or irregular respirations (e.g. gasping)
   - Pulse cannot be confidently auscultated or identified on palpation of the umbilical cord
2. Signs of inadequate perfusion:
   - Centrally pale or cyanosed
   - Pulse less than 100
3. Inadequate respiratory effort:
   - Rib/sternal recession
   - Retraction or indrawing
   - Persistent expiratory grunting

Question 2

List some important considerations in newborn resuscitation.

Answer 2

• Only 15% of newborns require supplementary cares such as stimulation, airway positioning or positive pressure ventilation
• The newborn should be placed supine with their head supported in a neutral position (avoiding flexion/extension of the neck) this can be achieved by placing a towel or blanket behind the shoulder blades of the newborn
• It is imperative that the temperature of the newborn is regulated & maintained (this can be achieved through the use of blankets & applying booties & a beanie)
• If active resuscitation of the newborn is required, delayed cord clamping (>60 sec) is recommended
  if possible
• Commencing resus in extremely preterm (<20 weeks) is not recommended
• Preterm babies (<34 weeks gestation) require additional methods of thermal care, CCP & the use of PEEP
• If central cyanosis persists for longer than 10min, commence O2 @2LPM until the newborn appears centrally pink

Question 3

What are the SPO2 targets for a newborn?

Answer 3

Time after birth:

1 min 60-70%
2 min 65-85% 
3 min 70-90%
4 min 75-90%
5 min 80-90%
10 min 85-90%

Question 4

Outline the protocol for newborn resuscitation.

Answer 4

Full term gestation and evidence of:

• Good tone
• Vigorous breathing or crying
• Heart rate >100/min

1. Stimulate the newborn
2. Ensure airway patency (neutral head position)
3. Normothermia maintained

Heart rate >100/min and adequate breathing?

If yes, continuously reassess the newborn. If centrally cyanosed 10 mins after birth consider O2 at 2 LPM.

If no, commence IPPV @40-60/min (room air)

• Pulse oximetry placed on right hand
• Reassess after 30 sec

Heart rate >100?

If yes, continuously reassess the newborn. If centrally cyanosed 10 mins after birth consider O2 at 2 LPM.

If no, commence IPPV (high concentration O2)
Consider:
- 2 person BVM technique
- PEEP (5 cm H2O)

Heart rate >60?

If no, commence CPR (3:1) 
Consider:
- Access 
- Adrenaline 
- Sodium chloride 0.9% 

Transport to hospital with pre-notification as required