Newborn: Routine Care and Resuscitation

Question 1

What are the characteristics of a newborn requiring no additional resuscitation?

Answer 1

4 characteristics:

• 1. A term infant
• 2. Clear amniotic fluid with no evidence of meconium and infection
• 3. Spontaneous breathing and crying
• 4. Good muscle tone

Question 2

What is the APGAR system?

Answer 2

Objective means to assess newborn condition.

• 5 signs
• scored 0 / 1 / 2 at
• 1 and 5 mins (and every 5 mins until 20 if under 7)

Question 3

What are the signs assessed by APGAR?

Answer 3

• Appearance
• Pulse
• Grimace
• Activity
• Respiration

Question 4

What is indicated by different APGAR scores?

Answer 4

• Apgar 7-10 = infant who requires no active resuscitation
• Apgar 4 - 7 = mild to moderately depressed infant
• Apgar <4 = severely depressed infant requiring immediate resuscitative efforts

Question 5

What are the components of routine care of the newborn?

Answer 5

• 1. Body temp
• 2. Umbilical cord
• 3. Vital signs
• 4. Mother contact

Question 6

How is newborn body temp maintained?

Answer 6

• thoroughly dry
• warm blankets
• skin to skin contact
• heater
  If pre term:
• warming pads
• radiant heater

Question 7

What is transitional care ?

Answer 7

Continued close observation for stabilisation - transition period (6-12h after birth).

• Prophylactic erythromycin or tetracycline to both eyes to prevent gonococcal ophthalmia neonatorum
• Vitamin K
• Monitor voiding pattern and bowel motions

Question 8

What are the signs of a compromised newborn?

Answer 8

• Not crying
• Not breathing or gasping
• Very floppy
• Bradycardia
• Persisting cyanosis

Question 9

What stimulates closure of ductus arteriosus?

Answer 9

• increase in systemic vascular resistance
• decreased pulmonary vascular resistance
  = functional closure of DA

Question 10

Describe use of the Neopuff.

Answer 10

• 1. Check gas connected
• 2. Use flow rate 10L / min
• 3. Set pressures (25 <36w; 30 >36w)
• 4. Ensure there is good seal
• 5. Ventilate lungs at 40 - 60 breaths / min
• 6. Ensure chest wall and upper abdomen moves with each inflation

Question 11

What is required if no detectable heart beat?

Answer 11

Asap intubation

Question 12

Causes of failure to response post intubation?

Answer 12

• Tube in oesophagus
• Tube too far
• Malfunction
• Pneumothorax
• Effusion
• Diaphragmatic hernia

Question 13

Chest compressions or ventilation more important in neonatal resus?

Answer 13

Ventilation

Question 14

Describe chest compressions in neonatal resus?

Answer 14

• Pressure to lower half sternum, keep in midline, avoid xyphoid process.
• Compress 1/3 AP diameter chest
• Avoid simultaneous compression / inflation

Question 15

How may adrenaline be administered to newborn?

Answer 15

• Umbilical vein most rapidly accessible route for fluid and medication administration
• Endotracheal tube (if adrenaline: much larger doses required than standard)
• Peripheral IV line
• Intraosseous access
• Intramuscular

Question 16

When is newborn resuscitation discontinued?

Answer 16

No response with measurable HR after 10 mins

Question 17

Equipment required for anticipated newborn resus?

Answer 17

• 1. Radiant warmer on
• 2. O2 source open and adequate flow
• 3. Suction tested
• 4. Laryngoscope functional and light checked
• 5. Bag and mask shows adequate seal and pressure

Question 18

What are the broad steps of neonatal resuscitation for infant with HR below 60bpm?

Answer 18

• Warm, stimulate, suction, position
• PPV
• ETT or laryngeal if needed
• Intubate if not already
• Chest compressions
• IV adrenline