Part 15: Neonatal Resuscitation Flashcards
What is the AHA2010 recommendation regarding the use of PEEP?
PEEP is likely to be beneficial and should be used if suitable equipment is available.
What is the advantage of assessing umbilical pulse?
It is more accurate than palpation at other sites
What 3 vital characteristics should be simultaneously evaluated once positive pressure ventilation or supplementary oxygen administration is begun?
Heart rate Respirations State of oxygenation
What inflation pressures should be used if pressure monitoring cannot be used?
Minimal inflation required to achieve an increase in HR
What fluid is recommended for volume expansion in newborn baby in the delivery room?
Isotonic crystalloid solution or blood
What is the recommended volume expansion dose?
10ml/kg which may need to be repeated
Is there any difference in attaching the oximeter probe to the baby before connecting the probe to the instrument?
There is some evidence that it facilitates the most rapid acquisition of signal (Class IIb, LOE C)
When should volume expansion therapy considered in newborn infant reuscitation?
When blood loss is known or suspected (pales skin, poor perfusion, weak pulse) and baby’s HR has not responded adequately to other resuscitative measures
What can suctioning of the nasopharynx cause during resuscitation?
Bradycardia
How should the assessment of heart rate be done?
Intermittently auscultating the precordial pulse When pulse is detectable, palpation of the umbilical pulse
What is considered a very low birth weight in preterm babies?
< 1500g
What is the target glucose concentration range in neonatal resuscitation according to AHA 2010?
There is no specific target glucose concentration range that can be identified at present
What condition usually causes bradycardia in newborn infant?
Inadequate lung inflation or profound hypoxemia
What complications in newborns born to febrile mothers have been reported to have higher incidence?
Perinatal respiratory depression Neonatal seizures Cerebral palsy Increased risk of mortality
When should the oxygen concentration be increased to 100% during neonatal resuscitation?
If the baby is bradycardic (HR < 60 per minute) after 90 seconds of resuscitation with a lower concentration of oxygen until recovery of a normal heart rate
When, during resuscitation, should the LMA be considered?
If face mask ventilation is unsuccessful and tracheal intubation is unsuccessful or not feasable
When is suctioning immediately following birth recommended?
For babies who have obvious obstruction to spontaneous breathing or who require positive-pressure ventilation
What is the recommended oxygen saturation goal in babies being resuscitated at birth, whether born at term or preterm?
1 min 60-65% 2 min 65-70% 3 min 70-75% 4 min 75-80% 5 min 80-85% 10 min 85-95%
When should PPV be started during neonatal resuscitation?
If the infant remains apneic or gasping, or if the heart rate remains < 100 per minute after initial steps
What should a paramedic asses if heart rate does not improve?
Chest wall movement
What are the four categories of action for a baby that requires resuscitation?
Initial steps in stabilization (warmth, clear airway if necessary, dry, stimulate) Ventilation Chest compressions Administration of epinephrine and/or volume expansion
What is the current recommendation regarding suctioning of non-vigorous babies with meconium-stained amniotic fluid?
There is no change recommended in the current practice of performing endotracheal suctioning of nonvigorous babies with meconium stained fluid
What should be done with the baby if not requiring resuscitation after birth?
Baby should be dried placed skin-to-skin with the mother, and covered with dry linen to maintain temperature
What elements of assessment are regarded as poor indicators of the state of oxygenation and saturation during the immediate neonatal period?
Clinical assessment of skin colour Lack of cyanosis
What are the initial steps of neonatal resuscitation?
Provide warmth by placing baby under radiant heat Positioning head in sniffing position to open the airway clearing the airway if necessary with a bulb syringe/suction catheter drying the baby, and stimulating breahing
How should assisted ventilation be delivered in neonatal resuscitation?
40 to 60 breaths/minute to promptly achieve or maintain a HR > 100/min
What are the indications for intubation during neonatal resuscitation according to AHA 2010?
Initial endotracheal suctioning of nonvigorous meconium-stained newborns If bag-mask ventilation is ineffective or prolonged When chest compressions are performed For special resuscitation circumstances, such as congenital diaphragmatic hernia or extremely low birth weight
In what newborns weight has LMA been shown to be effective?
> 2000g or delivered >= 34 weeks gestation
Which chest compression technique is recommended in neonatal resuscitation and why?
2 thumb-encircling hand technique It may generate higher peak systolic and coronary perfusion pressure than 2-finger technique
When is it appropriate to consider stopping resuscitation in a newly born baby?
No detectable HR for 10 minutes in a newly born baby
What observation should be ongoing even for a baby that does not require resuscitation?
Breathing activity? Colour?
What peak inflation pressures might be needed in some term babies without spontaneous ventilation?
>=30 to 40 cmH2O
What is the best indicator that the tube is in the tracheobronchial tree and providing effective ventilation?
Prompt increase in heart rate
What are the anatomical characteristics in preterm babies and what complications might be associated with these characteristics?
Immature lungs, possibly difficult to ventilate more prone to injury by positive-pressure ventilation Immature blood vessels in the brain that are prone to haemorrhage Thin skin and large surface area, which contribute to rapid heat loss Increased susceptibility to infection Increased risk of hypovolemic shock related to small blood volume
What assisted ventilation rates are commonly used?
40 to 60 breaths/min
When is oximetry recommended in assessment of newborns?
When resuscitation can be anticipated When positive pressure is administered for more than few breaths When cyanosis is persistent, or when supplementary oxygen is administered
What can aspiration of meconium before delivery, during birth, or during resuscitation cause?
Severe meconium aspiration syndrome (MAS)
Is Naloxone recommended as part of initial resuscitative efforts in the delivery room for newborns with respiratory depression?
No
What is the optimal pressure, inflation time, and flow rate required to establish an effective FRC and PPV during neonatal resuscitation?
It has not been determined
What three main characteristics, identified by a rapid assessment generally indicate the need for resuscitation?
Term of gestation? Crying or breathing? Good muscle tone?
What factors should be considered when deciding to continue resuscitation effort beyond 10 minutes?
Presumed etiology of the arrest Gestation of the baby Presence or absence of complications Potential role of therapeutic hypothermia The parents’ previously expressed feelings about acceptable risk of morbidity
What is the correct landmark and depth for neonatal chest compressions?
Lower third of the sternum Approximately one third of the anterioposterior diameter of the chest
How many weeks of gestation define preterm delivery?
< 37 weeks
What initial inflation pressure may be effective?
20 cmH2O However, the initial peak inflating pressure needed are variable and unpredictable and should be individualized to achieve an increase in HR or movement of chest with each breath
What 2 vital characteristics determine the decision to progress beyond initial steps of resuscitation?
Respirations (apnea, gasping, or laboured or unlaboured breathing) Heart rate (> or < 100b/min)
When are chest compressions indicated during neonatal resuscitation?
HR < 60b/min despite adequate ventilation with supplementary oxygen for 30 seconds
What should be avoided and why, during fluid administration ,when resuscitating premature infants?
Avoid giving volume expanders rapidly, because rapid infusions or large volumes have been associated with intraventricular haemorrhage
Is it true that majority of newborns who will need resuscitation can be identified before birth with careful consideration of risk factors?
Yes
What is the precaution for endotracheal suctioning of babies with meconium-stained amniotic fluid?
If attempted intubation is prolonged and unsuccessful bag-mask ventilation should be considered, particularly if there is persistent bradycardia
What additional warming techniques are recommended for very low birth weight preterm babies?
Pre warming the delivery room to 26 degrees C Covering the baby in plastic wrapping (food or medical grade, heat-resistant plastic) Placing baby on an exhothermic mattress, and Placing baby under radiant heat (Class IIb, LOE C)
What is the most sensitive indicator of a successful response to each step in the resuscitation algorithm?
Increase in heart rate
What is the ratio of chest compressions to ventilations for neonatal resuscitation?
3 : 1
What other techniques for maintaining newborn’s temperature during stabilization are recommended but have not been studied specifically?
Pre-warming the linen Drying and swaddling Placing baby skin-to-skin with the mother and covering both with a blanket
What is the AHA 2010 recommendation regarding compression ratio?
Rescuers should consider using higher ratios (eg. 15:1) if the arrest is believed to be of cardiac origin
What complications can arise as a result of routine suctioning of the trachea in intubated babies receiving mechanical ventilation in the nenonatal ICU? (in the absence of obvious nasal or oral secretions)
Deterioration of pulmonary compliance and oxygenation and reduction in cerebral blood flow velocity
Has tracheal suctioning resulted in reduction in the incidence of MAS or mortality in depressed infants born to mothers with meconium-stained amniotic fluid?
No
For how long should the initial steps of stabilization take to complete reevaluating and beginning ventilation if required
Approximately 60 seconds
What elements in care are critical for successful neonatal resuscitation?
Anticipation Adequate preparation Accurate evaluation Prompt initiation of support
What is the oxyhaemoglobin saturation value in newborns several minutes after birth?
70 - 80%
Which group of infants is at increased risk to develop meconium aspiration syndrome?
Depressed infants born to mothers with meconium-stained amniotic fluid
What do initial inflations following birth, either spontaneous or assisted, create in the lungs?
Functional residual capacity (FRC)
What is the recommended optimum inflation time?
There is insufficient evidence to recommend an optimum inflation time
What is the primary measure of adequate initial ventilation during neonatal resuscitation?
heart rate
What is the limitation of pulse oximeter application during neonatal resuscitation?
It takes 1 to 2 minutes to apply, and it may not function during states of very poor cardiac output or perfusion
How should the saturation targets be achieved during resuscitation?
Initiating resuscitation with air or blended oxygen titrating the oxygen concentration to achieve an SpO2 in the target range If blended oxygen is not available, resuscitation should be initiated with air
