Newborn life support

Question 1

Foetal response to labour

Answer 1

-hypoxic event
Cope by:
-higher and different Hb (higher affinity
-heart can continue beating for 20 mins without oxygen
-brain withstands longer without oxygen than an adult

Question 2

Transition to extra-uterine life

Answer 2

-first breath stimulated by- mild hypoxia of labour, increase arterial CO2, meet air due to chemoreceptors in throat
-with first breath, lung fluid drains, reabsorbed into circulatory and lymphatic system
-most first breath within 10-30 secs
-effective breathing within 90-120 secs

Question 3

What a well baby looks like

Answer 3

-born blue but becomes centrally pink after 90 seconds
-good tone- not floppy
-cries within few seconds of birth
-good HR- 100-160bpm

Question 4

What a less well baby looks like

Answer 4

-blue at birth, doesn’t pink up quickly
-reduced tone- bit floppy
-inadequate or absent respirations
-slow heart rate- less than 100bpm

Question 5

What an unwell baby looks like

Answer 5

-born pale
-floppy
-not breathing
-HR under 60 or undetectable
-commence resus

Question 6

Equipment needed

Answer 6

-maternity pack
-laryngoscope
-OPA and tongue depressor
-temp probe
-towel
-stethoscope
-BVM
-O2
-sats probe

Question 7

Standard approach

Answer 7

1.dry and cover baby, skin to skin with mum, cord intact, stimulating if necessary
2.assess
3.airway
4.breathing
5.circulation

Question 8

Step 1 of standard approach (stimulate)

Answer 8

-dry with towel
-discard wet towel and cover in fresh towel
-heat loss can be rapid so be aware
-if not breathing within few seconds stimulate

Question 9

Step 2 standard approach

Answer 9

Assess
Colour- pink, blue, white, trunk, lips, tongue
Tone- flexed or floppy
Breathing- present, absent, type
HR- stethoscope on apex

-if concerned about any of these features:
-clamp and cut cord
-take to resus area
-cover with warm towel and put hat on
-colleague or father calls for backup
-call central delivery suite for support

Question 10

Step 3 of standard approach

Answer 10

Airway
-ensure its open
-lie on back
-head neutral position
-chin support
-jaw thrust may be necessary
-place towel under babies’ shoulders

Question 11

Step 4 of standard approach

Answer 11

Breathing
-chose correct mask
-start 5 inflation breaths give over 2-3 seconds
-should see chest rise and fall after 4th or 5th
-re-assess - HR, tone, breathing, colour
-if successful HR will increase and baby will respond
-continue with ventilation breathes
-if no rise and fall consider problems (position, maybe need OPA, no seal

Question 12

Why resus with air not O2

Answer 12

-begin with air
-as replacing babies normal first breath
-if resus prolonged consider introducing O2, guided by SPO2

Question 13

Problems with aeration (why chest isn’t rise and fall)

Answer 13

-head not in neutral position
-air leakage
-were inflations long enough
-try 2 handed jaw thrust
-if no help, OPA
-consider observing obstruction with laryngoscope

Question 14

Step 5 of standard approach

Answer 14

Circulation
-when chest rise and fall, HR should increase
-if chest has risen but HR not increasing, ventilate 30 secs at 30-40/min
-if HR still not rising commence compressions at ratio of 3:1 with ventilation
-don’t start chest compressions if no chest rise and fall, as no point

Question 15

Chest compression

Answer 15

-2 thumb encircling or 2 finger
-1/3 depth of chest
-3 compressions: 1 ventilation (even with i-gel)
-reassess every 30 secs

Question 16

Post birth care and monitoring

Answer 16

-after resus or during resus arrange time critical transfer to NICU for obs or continued resus
-record rate and type of breathing, HR and colour
-take and record axillary temperatures

Question 17

Transfer to NICU

Answer 17

-pre alert to hospital
-heat ambulance, use transwarmer
-consider how to continue resuscitative measures
-must continue care for mother, may need 2 ambulances to transfer separately (only if absolutely necessary)
-take mums maternity notes

Question 18

Documentation

Answer 18

-note time of head birth, first breath, when get normal HR
-document all communication with colleagues and all decisions

Question 19

Newborn life support algorithm

Answer 19

Chest rise?
yes- continue maintenance breaths until HR normal
no- reset airway, jaw thrust, OPA, 5 more breaths, reassess, keep going until rise and fall
Chest rise?
yes and HR increase- give breaths as necessary
yes but no HR increase- 30 ventilations, reassess, HR not increasing start compressions
no- repeat airway adjustments and inflation breaths, no compressions