OGCO neonatal resuscitation

Question 1

What are routinely ordered for delivery?

Answer 1

• HBV 0.5ml (10ug) IM for babies with birth weight >2000g if the mother is a known HbsAg carrier, give HBIG 05ml IM together wtih HBV 0.5ml stat at the contralateral thigh irrespective of birth weight. If maternal hep status not known, urgent maternal HBsAg status should be checked. HBIG should be given within first 12 hours of life if mothers blood test results come back to be HbsAg+ve or unavailable by then.
• Vit K1 1mg IM should be given
• Withhold all IM medication if bleeding diathesis is suspected
• Cord blood saved fro G6PD and thyroid screening (cord blood for TORCH not routinely saved unless in cases when congenital infection is suspected)

Question 2

If baby admitted into SCBU what should be tested?

Answer 2

• Placenta kept at 4C in labor ward for 24 hours if the baby requires admission to SCBU. Send the placenta for histological section if admitted into NICU.

Question 3

When is breastfeeding initiated?

Answer 3

• Within 30 minutes of life in labor ward
• Babies at risk of hypoglycemia should be inititated on feeding within 1 hour

Question 4

When is baby considered safe to transferral to postnatal ward?

Answer 4

• If the spO2>95% in room air is acceptable
• q15 monitoring of spO2 in the 1st hour till transferred out

Question 5

What is recorded in the baby when delivered?

Answer 5

• rectal temperature
• Body weight
• length and head circumference

Question 6

Indications for paediatric standby for high risk pregnancy?

Answer 6

Question 7

What are the neonatal resuscitation steps?

Answer 7

Start stop clok
* Baby under radiant heat warmer
* Airway management: position neck, clear airway (gentle suction to orothan nasopharynx (suction pressure 80-100mmHg)
* Provide warmth: dry baby with warm towel
* Assess need for further resuscitation: breathing effort, HR, color, general activity
* If signs are good and baby is vigorous –> provide warmth and general routine newborn care, complete PE, APGAR scores

• If breathing absent or irregular –> start PPV (attach preductal saturation monitor)
• Assess HR after face mask baggin for 30 secs: start external chest compression if HR <60/min
• Assess HR again 60 secs after ECC
• Advanced life support: consider intubation if ECC required or for drug administration (adrenaline). Sodium bicarbonate not routinely given to babies with metabolic acidosis. Can consider volume expander (NS or O negative packed RBC) if hypovolemia suspected (pallor, weak pulses, history of placenta previa/ vasa previa), babies with respiratory depression due to maternal narcotic use during labor should be given PPV.
  Insert NG tube for stomach decompression when resuscitation is prolonged

Question 8

How to manage meconium stained liquor?

Answer 8

It is a sign of post maturity but may reflect fetal distress (should be CFHM)

Not routinely performed endotracheal suction for non-vigorous babies delivered through meconium stasined fluid.

Only if not able to achieve chest movement despite all the ventilation corrective steps and properly placed endotracheal tube there may be thick meconium obstructing the airway. Than one may attempt to clear the airway using a suction catheter inserted through the endotracheal tube or by applying suction directly to the endotracheal tube using a meconium aspirator.

Question 9

When should resuscitation be stopped if response to resuscitation is poor?

Answer 9

Poor neurological prognosis and survival have been shown when
1. HR returned only after 10 minutes of life despite effective resuscitation 2. Spontaneous respiration returned after 20 minutes of life

In general, we should consider stopping resuscitation if there is no sustained sign of life after 20 minutes of resuscitation. The timing also depends on (1) gestational age (2) presence of major malformations.

Question 10

What are the indications for non initiation of resuscitation?

Answer 10

This may include the following conditions:
1. extreme prematurity <22 weeks
2. lethal or major chromosomal abnormalities e.g. Trisomy 13, Trisomy 18
3. other significant congenital malformations of poor prognosis (provided reliable prenatal diagnosis is made)

Question 11

Algorithm for neonatal CPR

Answer 11

Question 12

Corrective steps if PPV is not working for resuscitation

Answer 12

Question 13

APGAR scores

Answer 13

Question 14

Method for tactile stimulation

Answer 14

Question 15

Method for free flow oxygen delivery

Answer 15

Question 16

How to synchronize venilation and external chest compression?

Answer 16

Question 17

Endotracheal guide for depth of insertion

Answer 17

Question 18

Drugs used in neonatal resuscitation?

Answer 18