Newborn Life Support

Question 1

NLS Diagram

Answer 1

Question 2

Newborn Transition

Answer 2

Renamed as rarely need resuscitation but simple, supportive measures.

85% of babies will initialy spontaneous respirations within 10-30 seconds of birth.

10% more with drying and stimlation (95%)

3% after positive pressure ventilation (98%

Question 3

Foetal Circulation

Answer 3

The change in foetal circulation occurs at point of birth; newborn needs time to adapt to life; need to catch their breath.

Question 4

Heat Loss

Answer 4

Dry baby rapidly, baby loses heat quickly.

Question 5

Cord Clamping

Answer 5

Do not clamp cord until it has stopped pulsating, leave it there until compressions if required.

Question 6

Newborn 1 ) The Healthy Baby

Answer 6

Born blue but with good tone and breathes spontaneously within 1 minute of birth.

HR >100 by 2 minutes.

Becomes pink within first 2 minutes

Question 7

Newborn 2) The Less Healthy Baby

Answer 7

Born blue, reduced tone, slow HR, may not breathe adequately by 2 minutes.

Question 8

Newborn 3) The ill baby

Answer 8

Born pale and floppy, not breathing with slow HR <60bpm.

Assess and treat with cord intact if possible as benefits of cord blood

Do not clamp cord for at least 1 minute

Question 9

Airway

Answer 9

Less healthy / ill baby will require opening airway

Prominent occipate can lead to occlusion of delicate airway

Place a small roll under shoulders, do not hyperextend the neck

Suction rarely needed

Question 10

Aeration of the Lungs

Answer 10

During birth, 100-150ml fluid is forced out of lungs; first breath causes expansion of alevolar tissue.

Lung aeration provides transition to life - AIR ONLY!!! - paed BVM

5x inflation breaths, 2 - 3 seconds.
See chest rise and fall after 3rd inflation breath

No R+F? Reassess airway

Question 11

Airway reassessment

Answer 11

• Head in neutral position?
• Jaw thrust?
• Longer inflation time?
• Help with airway from some else?
• Oropharyngeal obstruction? Use laryngoscope.
• OPA needed?

Do not move on until chest moving

Question 12

Assess HR

Answer 12

Once the chest wall is moving, assess heart rate

If baby’s heart rate remains below 60BPM, ventilations required

Question 13

Ventilation Breaths

Answer 13

30-40 per minute, one every 2 seconds for 30 seconds

SPO2 probe around right hand

No response to ventilation breaths? CPR

Question 14

ECG

Answer 14

Use ECG probes, do not place pads as usually not cardiac nature

Question 15

Chest Compressions

Answer 15

Most will not require CCs as will respond to lung aeration with HR increase within 30 seconds.

In some cases, may require CCs; only start when we see chest wall movement

Encircling technique if possible
1/3 chest depth
Purpose in newborn is to move oxygenated blood to coronary arteries to initiate cardiac recovery
No lung aeration? Blood will not be oxygenated, pointless; ensure aeration first (R+F).

Only usually needed for 20-30 seconds - 3:1 ration. Check HR every 30 seconds with a stethoscope.

Question 16

Special Considerations

Answer 16

High O2 concentrations can be toxic to newborn lungs, use air only

O2 should only be used once chest wall is moving and chest compressions are taking place, guided by oxymetry

Question 17

Pre-ductal O2 readings

Answer 17

Question 18

Meconium

Answer 18

Do not attempt to aspirate nose and mouth without direct vision

If baby is born through thick meconium & does not respond, visually inspect airway and suction accordingly