newborn resuscitation

Question 1

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Newborn resuscitation algorithm

Answer 1

Newborn resuscitation
1. Dry baby and maintain temperature
2. Assess tone, respiratory rate, heart rate
3. If gasping or not breathing give 5 inflation breaths*
4. Reassess (chest movements)
5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1

*Inflation breaths are different from ventilation breaths. The aim is to sustain pressure to open the lungs.

Question 2

A neonate who underwent a traumatic delivery is unresponsive. After being dried with a towel, it is noted that he is floppy with a heart rate of 58 bpm and has not taken his first breath yet. What is the next step in his management?

Give 2 rescue breaths
give 5 inflation breaths
start chest compression
intubate to secure the airway
gain venous access

Answer 2

B
Neonatal resuscitation follows a step-by-step process listed in the following. It is worth noting that ‘inflation breaths’ are the preferred term in neonatal resuscitation as it is designed to inflate the lungs and promote the clearance of fluid from the lungs. These breaths are slower and more prolonged than ‘rescue breaths’ used in basic life support. The neonatal resuscitation protocol differs from adult resuscitation protocols as it focuses mainly on respiratory as opposed to cardiac resuscitation. This is because the main cause of the bradycardia in neonates is hypoxia.
1.
Dry the baby
2.
Assess tone, breathing rate, and heart rate
3.
If gasping or not breathing → give 5 inflation breaths
4. Reassess
5. If chest is not moving → consider 2-person airway control and repeat inflation breaths
6. If chest is moving but heart rate is <60 bpm → ventilate for 30 seconds
7. Reassess → if heart rate <60 bpm → start chest compressions with ventilation breaths (3:1)
8 Reassess every 30 seconds
9. If heart rate remains <60 bpm → consider venous access and drugs (e.g. atropine)

Question 3

A newborn is delivered at 40 weeks gestation. Following delivery, the infant demonstrates poor muscle tone, gasping respirations, cyanosis and a heart rate of 80bpm. APGAR score is 3 and the newborn is placed in the sniffing position for airway maintenance. On reassessment, no changes are noted. Following positive pressure ventilation for 30 seconds the newborn is now showing shallow respirations and a heart rate of 50bpm. Chest compressions are initiated. What is the recommended compression: ventilation ratio for the newborn?

5:1
2:1
3:1
3:2
5:2

Answer 3

3:1

A healthy newborn will be pink with good tone and will cry within seconds of being delivered. The heart rate of a healthy newborn infant is 120-150bpm. This infant has poor tone, is gasping for air and a low heart rate. As no changes are noted on reassessment and the heart rate has fallen this warrants compressions. Newborn resuscitation guidelines recommend compressions and ventilations at a rate of 3:1, therefore, this is the only correct answer.