Newborn Resuscitation

Question 1

What is the key to newborn resuscitation?

Answer 1

Effective ventilation - most newborns requiring resus are apnoeic and bradycardic. Effective ventilation should be prioritised at each stage of resus.

Question 2

In the non-vigorous newborn, how quickly should ventilation be initiated?

Answer 2

In the first 60s.

Question 3

Initial ventilation of the newborn should occur with supplemental O2 - true or false?

Answer 3

False. Ventilate at 40-60 ventilations per minute with enough pressure to see chest rise and fall.

Question 4

What PEEP should be used for IPPV in newborn resus?

Answer 4

5cm H2O

Question 5

In a newborn resus, if HR remains 60-100bpm after 30s of ventilation on room air, ensure adequate…?

Answer 5

Mask seal, airway position and ventilation pressure.

If after this, still <100bpm, initiate 5L/min O2.

Question 6

Once HR >100 and target SPO2 is being met, should O2 be weaned in a newborn resus?

Answer 6

Yes, to avoid hyperoxaemia.

Question 7

In a newborn resus, if HR is still <60bpm, despite at least 30s effective ventilation, what is required?

Answer 7

CPR with 100% O2.

Question 8

When should newborn resus not be initiated?

Answer 8

If<23 weeks.

Question 9

In what circumstances does a newborn need to be registered with a hospital/medical facility?

Answer 9

If born at ≥20 weeks OR
≥400g birth weight OR
showing signs of life regardless of gestation

Question 10

Are miscarriages <20 weeks required to be reported to the coroner or police?

Answer 10

No, unless it occurred due to violence/injury.

Question 11

What is the most effective airway positioning for a newborn resus?

Answer 11

Place head and neck in a neutral position.
Avoid excessive neck flexion and head extension.
Place a folded towel underneath the shoulders.

Question 12

How should a newborn airway be suctioned?

Answer 12

Only if obstructed.
Mouth, then nose - due to nasal breathing.
5-6s max and no deeper than the oropharynx to avoid spasm/bradycardia.

Question 13

Are OPA’s indicated in a newborn resus?

Answer 13

Not unless airway abnormalities or tongue obstruction, as it may cause vagally mediated bradycardia.

Question 14

How should HR be measured in the newborn?

Answer 14

Auscultate. If resuscitating, apply ECG dots to guide resus.

Question 15

If newborn in shockable rhythm, how is this managed?

Answer 15

Apply pads, defibrillate at 4J/kg at 2 min intervals.

Question 16

What is the compression to ventilation ratio for a newborn?

Answer 16

3:1
90 compressions to 30 ventilations with a 0.5s pause for ventilation.
Depth 1/3rd of chest
Use two thumb method

Question 17

If single rescuer, what is the priority in a newborn resus?

Answer 17

Ventilations.

Question 18

Outline flowchart for newborn resus.

Answer 18

APNOEIC/GASPING, OR NO MUSCLE TONE
Stimulate by drying, warm, prepare neutral airway.
Suction if required.
30s

HR <100 AND OR APNOEIC/GASPING
Ventilate at 40-60, attach dots and SPO2
Reassess after 30s

HR <60
cpr at 3:1 with 5L/min of O2
Reassess after 30s

                                   OR HR 60-100 ventilate at 40-60, if no increase in HR, 5L/min O2

                                   OR

HR >100 but SPO2 <90%
Laboured breathing: ventilate 40 to 60, titrate 1-5L O2
Normal breathing: maintain warmth, titrate 1-2L O2
Discontinue when SPO2 >90%