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NLS book Flashcards

1
Q

How long should you delay clamping of the cord by, in healthy babies?

A

At least 60s

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2
Q

Why is delayed clamping important?

A

Whilst the baby transitions from placenta respiration to normal respiration, there is redistribution of the blood between the placenta and the healthy baby. It also ensures the blood gained from the placenta is at maternal body temperature which helps keep the baby warm.

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3
Q

What inhibits surfactant production after birth?

A

Hypoxia, acidosis and hypothermia

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4
Q

Hypothermia in a new born is a strong predictor of mortality and morbidity, by what % does mortality increase by every 1 degree below 36.5 in pre-term babies?

A

28%

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5
Q

What are the four methods of heat loss for a new born baby and why are they at such high risk of it?

A 
They are at high risk due to their large surface area to volume ratio, and as they are born wet. 
The four methods of heat loss are:
1. Evaporation
2. Convection
3. Conduction
4. Radiation
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6
Q

How can heat loss be prevented in a new born? (5)

A
  1. Dry the baby with pre-warmed towels
  2. Keep the delivery area draught free
  3. Maintain the environment temperature within the range 23-25 degrees
  4. Place the baby skin-to-skin and cover
  5. If the baby needs attention use a radiant heater to reduce the heat loss by radiation and conduction
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7
Q

What 4 things are important to assess in a new born baby?

A
  1. Colour
    2 Tone
  2. Breathing
  3. Heart rate
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8
Q

What colour do most babies look when they are first born?

A

Blue - they can remain blue for several minutes following birth and this does not mean the baby necessarily requires assistance

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9
Q

What to look out for in tone of a baby?

A

Is it well flexed with good tone or floppy?

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10
Q

What do you look out for in breathing of a new born baby? Why is stimulation such as drying important?

A

Rate and pattern of breathing.
Most will breathe or cry within 30 seconds and establish regular respirations by 60s. Without intervention such as drying, stimulation and beginning lung inflation, up to 20% of healthy babes may take 60-180s to establish regular breathing.

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11
Q

What sign related to breathing indicates a baby may need help?

A

Gasping respirations

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12
Q

Why is the rate of cord pulsation not an accurate reflection of a babies heart rate?

A

Pulsations are not always present, even in a healthy baby, and the rate of pulsation does not reflect the actual heart rate. If pulsations are >100bpm in the cord, it suggests all is well, but the reverse is not true.

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13
Q

What is the most accurate way of assessing a new born heart rate?

A

Listening with a stethoscope, however continuous monitoring provides a more dynamic indication of heart rate change during resuscitation and is preferable to intermittent counting. Methods include pulse oximetry and ECG.

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14
Q

What signs at birth indicate a baby may need for support?

A

A baby who is not breathing adequately, with a slow heart rate, or who is blue-white or floppy, should be dried and covered and where possible under a radiant heat source.
Further action may be required such as the umbilical cord being clamped and cut,

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15
Q

What blood glucose level can a new born baby have, and what does it survive on?

A

It can fall to 1-2mmol after birth, and the babies brain utilises the lactate and ketones available. Lactate is normally very high at birth and falls in the first few hours.

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16
Q

How long are ketones produced by the baby to be used as fuel whilst breastfeeding is established?

A

72 hours

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17
Q

What slightly increases the risk of sudden unexpected postnatal collapse?

A

Occurs slightly move in the context of skin-to-skin contact as the baby is prone as their airway is at a slightly higher risk of obstruction, and when breastfeeding. This however should not prevent either of these going ahead.

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18
Q

What does the term acidaemia mean?

A

Increased concentration of hydrogen ions in the blood

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19
Q

What does the term acidosis mean?

A

A respiratory acidosis - accumulation of CO2
A metabolic acidosis accumulation of acids such as lactate or any number of organic acids that accumulate in inherited metabolic conditions

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20
Q

What does the term anoxia mean?

A

A complete lack of oxygen in any tissue

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21
Q

What does the term asphyxia mean?

A

A condition in which an extreme decrease in oxygen in the body leads to loss of consciousness or death- the term is not used often as it has been replaced with more specific terms including - anoxia, hypoxia, hypercapnia

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22
Q

What does the term hypercapnia mean?

A

Abnormally high levels of CO2 in the blood

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23
Q

What does hypoxaemia mean?

A

Decreased oxygen content of the blood

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24
Q

What process of labour stimulates what by the fetus and mother?

A

Fetus produces adrenaline and the mother produces thyrotropin releasing hormone

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25
Q

What do both adrenaline and thyrotropin producing hormone do?

A

They cease the production of and begin to absorb, fluid from the alveolar space, preparing the lungs for respiration

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26
Q

In a healthy newborn baby, how long does it take for partial airway liquid clearance?

A

20 minutes (and 4 hours for complete clearance)

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27
Q

What placental problem can maternal hypertension cause?

A

Placental abruption - leading to congenital airway abnormalities

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28
Q

What maternal conditions can lead to umbilical cord prolapse which in turn can lead to sepsis, hydrops fetalis and hypovolaemia in the new born?

A
  1. Uterine rupture
  2. Sepsis
  3. Severe anaemia
  4. Hypotensive shock
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29
Q

What is the most frequent cause of perinatal hypoxia?

A

Interruption of placental blood flow

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30
Q

What are the three reasons babies can recover from periods of oxygen deprivation that more mature humans cannot endure?

A
  1. In response to hypoxia, the baby conserves energy by shutting down the circulation to all but the most vital organs.
  2. After a latent period called primary apnoea, automatic, spinally generated gasping activity appears
  3. New born babies hearts can utilise glycogen as an alternative fuel which allows it to provide an adequate circulation in the face of profound hypoxia and considerable biochemical disturbance, for a reasonably long time.
31
Q

What is the basic systematic approach of neonatal resuscitation?

A
  1. Dry and cover the baby
  2. Assess the situation and consider umbilical cord management
  3. Airway
  4. Breathing (inflation breaths, then ventilation breaths)
  5. Circulation (chest compression)
  6. Drugs
32
Q

What is the starting concentrations of oxygen advised in the following gestation age of babies:

  1. > 32 weeks?
  2. 28+0 - 32+0 weeks?
  3. <28 weeks?
A
  1. Air
  2. 21-30%
  3. 30%
33
Q

How long should ventilation be given before considering chest compressions in a new born?

A

30 seconds ventilation

34
Q

What target oxygen saturations would be sufficient to not required any supplementary oxygen?

A

> 95%

35
Q

If a babies heart rate is not responding despite adequate ventilation, supplementary oxygen is often used, how much oxygen should be given if requiring chest compressions?

A

100% oxygen

36
Q

When are chest compressions indicated in a new born?

A

If the heart rate is very slow (<60min) and there is no rise in heart rate despite lung inflation and ventilation, as judged by visible chest movement for 30 seconds, then chest compressions may be required

37
Q

In terms of the newborn life support resus pathway, if a baby is born <32 weeks, what do you do initially?

A
  • Place them undried in plastic wrap + radiant heat
  • Give inspired oxygen - 28-31 weeks (21-30%), <28 weeks (30%).
  • If giving inflations, start with 25cm H2O
38
Q

What is the first step in the resus guideline after birth (which includes delay cord clamping if possible)?

A
  1. Start clock/note time

2. Dry/wrap, stimulate, keep warm

39
Q

After the initial stage of drying and keeping warm, what is the next step in newborn resus?

A 
Assess:
Colour
Tone
Breathing
Heart rate
40
Q

After initial assessment, what is the next step in the newborn resus?

A

Ensure an open airway - in preterm consider CPAP

41
Q

In newborn resus, what do you do if the baby is gasping/not breathing?(3)

A
  1. Give 5 inflations (30cm H20) - start in air
  2. Apply PEEP 5-6cm H2O, if possible
  3. Apply SpO2 +/- ECG
42
Q

In the next stage of resus, after assessing for gasping/breathing, what do you do when reassessing if there is no increase in heart rate and/or no chest movement? (5)

A

If the chest is not moving:

  1. Check mask, head and jaw position
  2. Two person support
  3. Consider suction, laryngeal mask/tracheal tube
  4. Repeat inflation breaths
  5. Consider increasing the inflation pressure
43
Q

Upon reassessing after doing the ‘if the chest is not moving’ stages, if the heart rate has not increased and chest is not moving, what do you do?

A

If heart rate is not detectable or <60bpm, after 30 seconds of ventilation:

  • synchronise 3 chest compressions to 1 ventilation
  • increase oxygen to 100%
  • consider intubation if not already done or laryngeal mask if not possible
44
Q

How often after starting chest compressions and continued ventilation should the heart rate and chest movement be reassessed?

A

Every 30 seconds

45
Q

What should be done in as per the resus guidelines if the heart rate remains not detectable or <60bpm whilst compressions and ventilations are maintained?

A
  • Vascular access and drugs

- Consider other factors e.g. pneumothorax, hypovolaemia, congenital abnormality

46
Q

When might the heart rate decrease in a newborn?

A

If the cord is clamped immediately - a decrease in heart rate is not seen in babies with delayed cord clamping

47
Q

In terms of measuring oxygen saturations using a pulse oximeter, which limb will measure the pre-ductal saturations, and why is this important?

A

Right arm - as this shows the oxygen going to the brain - so always use the right arm

48
Q

What are the antenatal conditions that pose implications for neonatal resuscitation?

A
  1. Congenital heart disease
  2. Intathoracic masses (e.g. congenital diaphragmatic hernia)
  3. Neural tube defects
  4. Abdominal wall defects - e.g. gastroschisis
  5. Skeletal dysplasias
  6. Renal abnomalies
49
Q

Which factors are taken into consideration when determining umbilical cord management?

A
  1. How many babies are expected?
  2. What is the gestational age?
  3. Is the amniotic fluid clear?
  4. Are there any additional risk factors?
50
Q

In what situations are delayed cord clamping not less adviseable?

A
  1. Maternal haemorrhage
  2. Maternal seizure/cardiac arrest
  3. Placenta abruption
  4. Vasa previa
  5. Cord avulsion
  6. Fetal hydrops
  7. Twin-to-twin tranfusion syndrome
51
Q

Why should cord milking not be undertaken in infants <28 weeks gestation?

A

Excess intraventricular haemorrhage and marked haemodynamic fluctuations in arterial blood pressure and cerebral blood flow, can be injurious to the immature cerebral circulation.

52
Q

What is the correct head position for a neonate in resuscitation?

A

Neutral neck - not flexed or extended

53
Q

When may chin and jaw support be required in a new born?

A

If they are floppy it may be necessary to maintain their airway

54
Q

What inflation pressure is required in term babies needing resuscitation and over how many seconds is the breath given?

A

30cm water, applied for 2-3 seconds, repeated five times

if preterm this is 25cm water

55
Q

What are the three Ps for minimising face mask leak?

A

Position - rolling the mask onto the face (align, roll, check)
Pressure - balancing the pressure exerted on the mask by the finger and thumb
Pull - lifting or pulling the jaw upwards into the mask

56
Q

Face mask sizes are dependent on gestation age

Age 23 - 28 weeks generally wear which size mask?

A

35mm (28 may wear 42mm)

57
Q

Age 29-36 weeks generally wear which size mask?

A

42mm

58
Q

Age 37-term wear which mask?

A

50mm

59
Q

What is the babies first response to successful lung inflation and aeration?

A

Increase in heart rate

60
Q

If, after inflation breaths, the heart rate increases satisfactorily, but the baby is not breathing, what needs to happen?

A

Ventilation breaths

61
Q

If after inflation breaths, the heart rate has not increased and there are no chest movements?

A

Check head position and face mask, and repeat inflation breaths

62
Q

If there is not increase in heart rate, but you have seen chest movements during inflation breaths, what should you do?

A

Continue ventilation breaths

63
Q

If you do not see chest movements after the second set of inflation breaths, what is the most likely reason?

A

Airway obstruction - check the head is in a neutral position and the jaw has not been drawn forwards. Only rarely is the airway blocked by mucus, vernix, blood or meconium.

64
Q

When can laryngeal masks be used?

A

In babies whose weight is >2000g or who are over gestational age at birth of around 34 weeks

65
Q

When are oropharyngeal airways useful in neonate resus?

A

When there is some oro-facial abnormality like cleft palate, or when both jaw thrust and mask inflation is difficult on your own and help is not immediately available.

66
Q

Which technique for chest compressions on a neonate is most effective?

A

Two thumb technique

67
Q

What is the compression to ventilation ratio in neonatal resus?

A

3:1

68
Q

If effective ventilation and chest compressions have failed, what is given to increase the heart rate above 6bpm?

A

20mcg per kg adrenaline - preferrably IV but IO can be given (dose range 10-30mcg per kg is acceptable which facilitates dosing based on estimated weight)

69
Q

To prevent hypoglycaemia in prolonged resus, what is given?

A

IV or IO glucose, 250mg per kg bolus

70
Q

What are the suggested doses for resus drugs in a term baby?

A

Adrenaline - 0.7ml
Glucose 10% solution - 10ml
Volume NaCl 0.9% - 35ml
Sodium bicarbonate - 5ml

71
Q

When is sodium bicarbonate considered?

A

Prolonged unresponsive resus with adequate ventilation to reverse intracardiac aidosis

72
Q

When is volume replacement given in resus?

A

With suspected blood loss or shock unresponsive to other resus measures - 10ml per kg of group O RhD negative blood or 0.9% NaCl
Give a slow bolus over 2 minutes

73
Q

What is the preferred way of giving resus drugs?

A

Umbilical venous catheter (IO is an alternative)

74
Q

Which resus drug is the only one that can be given via a tracheal tube?

A

Adrenaline - it is not very effective though

NLS (1 decks)

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