NLS revision

Question 1

What is the total volume of fluid produced by the lungs?

Answer 1

20-30ml/kg

Question 2

Which substances are released by the fetus and mother in labour to help cease production of fluid in the lungs?

Answer 2

Adrenaline in the fetus
Thyrotropin release hormone in the mother

Question 3

At what stage can movements of the fetal chest be detected?

Answer 3

As early as 10 weeks

Question 4

What is the kPa in the umbilical artery of the fetus?

Answer 4

4.53kPa (vs 13.3kPa in the mother)

Question 5

In the healthy newborn, what factors stimulate respiration?

Answer 5

Skin stimulation
Skin cooling (in the absence of core temperature changes)

Question 6

What mechanism is responsible for airway liquid clearance after birth?

Answer 6

Hydrostatic pressures generated by inspiration

Spontaneous inspiratory movements by the newborn baby generate a transepithelial pressure gradient between the interstitial tissue and the airway lumen, and as a result the lung fluid is drawn from the proximal airways into the distal one where is is cleared across the distal airwavey wall into the surrounding interstitial tissue space

Question 7

How long does it take for complete airway liquid clearance?

Answer 7

Typically achieved within the first 4 hours

Question 8

What is the rate of gasping?

Answer 8

Approx. 12/minute

Shuddering whole body gasps

Question 9

What is the first sign of effective oxygen delivery to the heart?

Answer 9

A rise in heart rate

Question 10

What are the recommended initial oxygen concentrations to be delivered?

Answer 10

> 32 weeks - Air
28+0 - 32+0 - 21-30%
<28 weeks - 30%

Question 11

What are the acceptable right arm (pre-ductal) saturations?

Answer 11

2 minutes: 65%
5 minutes: 85%
10 minutes: 90%

Question 12

Which factors should be included in your assessment of the patient?

Answer 12

Colour
Tone
Breathing/ respiratory effort
HR

Question 13

What are the options for cord clamping?

Answer 13

1. At least 60 seconds of DCC unless it would prevent immediate resuscitation measures that are deemed necessary
2. If resuscitation is required, and 60s of DCC is not practical, then cord milking is an option in babies >28 weeks gestation (cord milking should not be practised in babies earlier than 28 weeks gestation)
3. Immediate cord clamping may be necessary

Question 14

What pressures should be used for inflation and ventilation breaths?

Answer 14

> 32 weeks: 30cm H2O
<32 weeks: 25cm H2O

Question 15

Which group are laryngeal masks useful in?

Answer 15

> 2000g or over gestational age of 34 weeks

Question 16

How is an oropharyngeal mask measured?

Answer 16

Flange in the middle of the lips and the other end should reach the angle of the jaw

Question 17

How should the deep trachea be suctioned?

Answer 17

Using an ETT attached to a meconium aspirator

Question 18

What is the rate of chest compressions?

Answer 18

You should be delivering 3 compressions to one ventilation breath at a rate of about 15 cycles every 30 seconds

Question 19

Where should chest compressions be delivered?

Answer 19

Over the lower third of the sternum

Question 20

How deep should chest compressions be delivered?

Answer 20

A a third of the depth of the chest

Question 21

How frequently should the HR be rechecked during chest compressions?

Answer 21

Every 30 seconds

Question 22

What is the preferred route to administer resuscitation drugs?

Answer 22

UVC
Secondly an IO could be used

Question 23

What is the only resuscitation drug that can be given via a tracheal tube?

Answer 23

Adrenaline although this route is less effective

Question 24

How frequently is adrenaline administered?

Answer 24

Every 3-5 minutes

Question 25

What is the dose of adrenaline in resuscitation?

Answer 25

0.2ml/kg of 1:10000 adrenaline every 3-4 minutes

Question 26

What is the dose of glucose in resuscitation?

Answer 26

2.5ml/kg bolus of 10% dextrose

Question 27

What is the fluid bolus in resuscitation?

Answer 27

10ml/kg 0.9% NaCl slow bolus over 2 minutes

Question 28

What is the dose of sodium bicarbonate in resuscitation?

Answer 28

1-2mmol/kg sodium bicarbonate slow IV injection

Question 29

How is APGAR scoring calculated?

Answer 29

Appearance: Blue, pale, pink
Pulse: <60, 60-100, >100
Grimace: No response, grimace, sneezes/coughs/cries
Activity: No activity, arms and legs flexed, good tone
Respiratory: Absent, gasping, crying

Question 30

What are the criteria for HIE therapeutic cooling?

Answer 30

Criteria A:
- APGAR less than or equal to 5 at 10 minutes of age
- pH <7.0 within 60 minutes of age
- Continued need for resuscitation including tracheal or mask ventilation at 10 minutes of birth
- Base deficit greater than or equal to 16 within 60 minutes of age

Criteria B:
Moderate to severe encephalopathy, consisting of altered state of consciousness (lethargy, stupor or coma) AND at least one of the following:
- Hypotonia
- Abnormal reflexes including oculomotor or pupillary abnormalities
- Absent or weak suck

Criteria C:
At least 30 minutes duration of EEG recording that shows abnormal background EEG activity or seizures. There must be one of the following:
- Normal background with some seizure activity
- Moderately abnormal activity
- Suppressed activity
- Continuous seizure activity