Resus of babies at birth

Question 1

How long should the cord remain unclamped for in uncompromised babies?

Answer 1

At least 1 minute from complete delivery

Question 2

Ventilatory support of term infants?

Answer 2

Start with air/low conc oxygen (30%)

Question 3

Preterm infant - spontaneously breathing but with distress - tx?

Answer 3

CPAP initially rather than intubation

Question 4

Newborn life support algorithm - talk through.

Answer 4

• Dry baby, normal temperature maintained.
• Assess: tone, RR, HR(use ECG)
• If gasping/not breathing: open airway and 5 inflation breaths.
• If no increase in HR, look for chest movement.
• Chest not moving?
  Recheck head position. ?2-person airway control. Repeat inflation breaths.
• Chest moving but heart rate not detectable/<60: start compressions with PPV (3:1)
• Reassess HR every 30 seconds. ?Consider drugs

Question 5

Acceptable pre-ductal SpO2 ?

Answer 5

2 minutes - 60%
3 minutes - 70%
4 minutes - 80%
5 minutes - 85%
10 minutes - 90%

Question 6

Why is there the delay in cord-clamping?

Answer 6

If clamped too early - bradycardia.
Reduced need for transfusion (higher Hb).
Higher mean BP.
Some studies - reduced inter ventricular haemorrhage/periventricular leukomalacia.

(Transient decrease in heart size if clamped too early - due to increase in pulmonary blood flow to the lungs)

Question 7

Newborn cold stress - impact?

Answer 7

Lower arterial tension and increase metabolic acidosis.

If preterm- increases risk of intraventricular haemorrhage, hypoglycaemia and late onset sepsis.

Question 8

For each degree drop in admission temperature below 36.5-37.5, how much does mortality increase?

Answer 8

28%

Question 9

Delivery room temperature: term and before 28 weeks.

Answer 9

Term - 23-25 degrees.

Preterm - above 25 degrees

Question 10

In terms of temperature control - what about a baby born before 32 weeks?

Answer 10

Immediate wrapping with polyethylene and placed under radiant heater. May also require: warm, humidified gases, cap, thermal mattress etc.

Question 11

What differentiates a baby that just needs drying, wrapping and mask inflation/rarely ventilations, from a baby that needs immediate airway control, lung inflation and ventilation/possibly chest compressions and drugs

Answer 11

If they are: floppy or have a low/undetectable HR.

Not if apnoea/inadequate breathing/ normal or reduced then or HR less than 100 - ALONE

Question 12

Routine intubation and suctioning for babies born through meconium?

Answer 12

Not evidence based - unless very thick, viscous meconium (indicates distressed baby)

Question 13

What would indicate successful lung inflations?

Answer 13

Prompt increase in Hr/chest wall rising

Question 14

Reasons for failure of airway control/ventialtion?

Answer 14

inappropriate positioning, airway obstruction, mask leak

Question 15

Level of PEEP in preterm newborns?

Answer 15

5cm H20

Question 16

Requirement for LMA in newborn?

Answer 16

Weighing over 2000g or delivered over 34 weeks.

Alternative to facemask for positive pressure ventilation. And to intubation.

Question 17

When might intubation be considered?

Answer 17

• Lower airway suctioning.
• If BVM ventilation is ineffective/prolonged.
• Chest compressions.
  Special circumstances - to give surfactant/congenital diaphragmatic hernia.

Question 18

Most effective neonatal chest compression technique?

Answer 18

Two thumbs over lower third of sternum, fingers encircling torso and supporting back.

Question 19

Drugs in neonates?

Answer 19

Adrenaline - as ALS guidelines, at a dose of around 10mcg/kg initially.
Can consider sodium bicarbonate (1-2mmol/kg) to reverse intracardiac acidosis

Question 20

Fluid replacement options?

Answer 20

NB: Rare
1. Blood - irradiated and leucocyte-depleted group O Rh-negative blood
2. Isotonic crystalloid
(10ml/kg)

Question 21

Treatment of moderate-severe hypoxic-ischaemic encephalopathy?

Answer 21

Therapeutic hypothermia 
(commence within 6 h of birth, continue for 72 h of birth and re-warm over at least 4 h)