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Resuscitation after birth Flashcards

1
Q

What is the effects of breathing difficulty immediately after delivery?

A

Breathing difficulty after delivery can lead to hypoxia and potential brain damage or death if not managed properly.

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2
Q

What are some possible causes of poor breathing in newborns?

A

prenatal hypoxia,
maternal anesthesia or
sedation, and
preterm or
difficult delivery.

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3
Q

Why is resuscitation sometimes necessary after birth?

A

Resuscitation may be required to assist newborns in transitioning from intra-uterine to extra-uterine life

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4
Q

What is the importance of anticipation in neonatal care?

A

Anticipation is crucial for identifying high-risk pregnancies, monitoring them during labor, intervening appropriately, and being prepared for potential resuscitation needs.

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5
Q

What is the ultimate goal of neonatal care?

A

The goal is to deliver each mother a healthy newborn with optimal potential for growth and development.

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6
Q

What should healthcare providers be prepared for in high-risk pregnancies?

A

They should be prepared to anticipate and manage potential resuscitation needs to ensure the best outcomes for both mother and baby.

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7
Q

What maternal factors are associated with high-risk pregnancies requiring resuscitation?

A
  • Teenage (< 16).
  • Elderly (> 35).
  • Low socioeconomic status
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8
Q

Name some maternal illnesses that may lead to the need for neonatal resuscitation.

A
  • Diabetes.
  • Hypertension.
  • Rh sensitisation.
  • Severe anaemia.
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9
Q

What previous pregnancy outcomes might indicate a need for resuscitation in subsequent pregnancies?

A
  • Previous miscarriages.
  • Previous stillbirths.
  • Previous early neonatal deaths
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10
Q

What factors related to the current pregnancy increase the likelihood of needing resuscitation?

A
  • No antenatal care.
  • Certain medications, illicit drugs, alcohol and smoking.
  • Pre-eclampsia.
  • Antepartum haemorrhage.
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11
Q

What fetal conditions during pregnancy suggest a higher risk of needing resuscitation at birth?

A
  • Multiple pregnancies.
  • Severe fetal growth restriction (especially with poor umbilical flow on Doppler).
  • Poor fetal movements in the last days of pregnancy.
  • Polyhydramnios or oligohydramnios.
  • Fetal abnormality.
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12
Q

What labor-related factors may increase the likelihood of neonatal resuscitation?

A

Abnormal presentation or position.
* Preterm or post-term labour.
* Poor progress in labour or prolonged labour.
* Cephalopelvic disproportion.
* Meconium staining or abnormal fetal heart rate.
* Instrument delivery or Caesarean section.
* Excessive maternal sedation

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13
Q

Why is it important for high-risk pregnancies to be delivered in hospitals with appropriate facilities?

A

These facilities are better equipped to handle potential complications and provide necessary interventions, including resuscitation if needed.

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14
Q

What happens to the fetal heart rate and blood circulation during hypoxemia?

A

The fetal heart rate decreases (bradycardia) as blood is shunted away from less vital organs to ensure sufficient supply to the heart and brain, protecting them during hypoxia stress.

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15
Q

Why does the fetus develop a physiological response to hypoxia?

A

The response aims to protect the brain and heart by ensuring adequate blood supply despite a decrease in cardiac output.

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16
Q

What additional complications can arise due to fetal hypoxemia?

A

Meconium passage and gasping respiratory movements, leading to aspiration of amniotic fluid and meconium into the upper airways.

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17
Q

When does fetal hypoxemia usually occur during labor?

A

It typically occurs transiently and intermittently towards the end of a uterine contraction when placental oxygen content is at its lowest.

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18
Q

How does delayed deceleration in fetal heart rate indicate fetal distress?

A

Delayed deceleration starting late in a contraction and continuing into relaxation suggests hypoxic stress on the fetus

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19
Q

What confirms severe hypoxia and metabolic acidosis in the distressed fetus?

A

Persistent baseline bradycardia or poor beat-to-beat variability on cardiotocography (CTG), which can be confirmed with cord gas analysis immediately after birth.(within 1 hr)

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20
Q

What immediate actions should be taken for a distressed fetus before delivery?

A

If there’s a delay in delivery, suppress uterine contractions (intravenous salbutamol or oral nifedipine) and optimize placental blood flow by turning the mother onto her side.

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21
Q

Why is fetal resuscitation particularly crucial if the mother needs to be transported to the hospital for delivery?

A

It ensures optimal fetal condition during transport and prepares for potential further interventions upon arrival.

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22
Q

How is significant fetal hypoxia confirmed clinically?

A

Significant fetal hypoxia is confirmed if the base deficit exceeds 10 mmol/l in arterial blood from the umbilical cord at birth or shortly after delivery.

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22
Q

When does a fetus become distressed and in danger of dying during labor?

A

When maternal blood supply to the placenta worsens, leading to fetal hypotension and tissue hypoxia, causing metabolic acidosis.

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22
Q

What is the primary biochemical marker of hypoxia before delivery?

A

The presence of metabolic acidosis in the infant at birth is the best marker

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22
Q

What is considered the best indicator of severe intrapartum hypoxia and resulting cerebral damage?

A

The development of neonatal encephalopathy is considered the best measure.

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22
Q

In what cases should the acid-base status of umbilical arterial blood be determined?

A

It should be determined in all cases of fetal distress or failure to breathe well after delivery, if possible.

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23
Q

Does the degree of metabolic acidosis indicate the severity or duration of fetal hypoxia?

A

No, the degree of metabolic acidosis does not correlate with the severity or duration of fetal hypoxia or the risk of cerebral damage.

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24
Q

What is HBB, and what does it aim to teach?

A

HBB stands for Helping Babies Breathe, an evidence-based training program focusing on neonatal resuscitation techniques in resource-limited areas.

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25
Q

What is the primary goal of HBB?

A

HBB aims to teach the initial steps of basic neonatal resuscitation to be completed within The Golden Minute, ensuring adequate breathing within the first minute of life to save lives and improve outcomes for newborns.

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26
Q

Apart from practical resuscitation steps, what are some key strategies included in HBB to improve neonatal outcomes?

A

Good communication between staff.
* Preparation and planning.
* Hand washing and cleanliness.
* Delayed cord clamping
Immediate skin to skin care.
* Breastfeeding.

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27
Q

Why is preparation essential in neonatal resuscitation?

A

Preparation ensures readiness to provide timely and effective care, which can be critical for the newborn’s survival and well-being.

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28
Q

What are some key principles of preparation in neonatal resuscitation according to HBB?

A

Providing a warm environment,
avoiding open windows or drafts,
maintaining a theater temperature of 26 degrees Celsius,
having warm dry towels,
utilizing a radiant heat source, and
maintaining clean hands are important principles.

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29
Q

How are ‘birth asphyxia’ or ‘neonatal asphyxia’ often defined?

A

They are often defined as the failure to initiate and sustain breathing after birth.

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30
Q

How do some authorities interpret ‘asphyxia’ in the context of labor?

A

Some interpret ‘asphyxia’ to mean impaired fetal gas exchange during labor, also known as intrapartum fetal hypoxia.

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31
Q

Why is there a discrepancy in the association between poor breathing after birth and abnormal neurological development?

A

Many infants who do not breathe well after birth have not experienced intrapartum hypoxia, while some infants with intrapartum hypoxia still manage to breathe spontaneously after delivery. Thus, the association between poor breathing after birth and abnormal neurological development is tenuous.

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32
Q

What is the Apgar score, and when is it typically assessed?

A

The Apgar score is an objective method of assessing an infant’s clinical condition after delivery, typically assessed at 1 minute after birth.

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33
Q

What should be done if the Apgar score at 1 minute is low?

A

If the 1 minute Apgar score is low, it should be repeated every 5 minutes until normal to document the infant’s condition objectively.

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34
Q

Why is it important to repeat the Apgar score if the 1 minute score is low?

A

Repeating the Apgar score every 5 minutes provides ongoing assessment of the infant’s condition and the success or failure of resuscitation attempts.

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35
Q

Is it necessary to wait for the 1 minute Apgar score before deciding on resuscitation?

A

No, it is not necessary to wait for the 1 minute Apgar score before deciding whether the infant needs resuscitation.

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36
Q

Acronym APGAR

A

Appearance
Pulse rate
Grimace
Activity
Respiratory effort

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37
Q

What are the components of the Apgar score?

A

The components include heart rate, respiratory effort, muscle tone, response to stimuli, and color.

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38
Q

What are the possible scores for each component?

A

Each component can be scored as 0, 1, or 2.

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39
Q

How is the heart rate assessed in the Apgar score?

A

It is assessed based on whether it is absent (0),
under 100 beats per minute (1),
or over 100 beats per minute (2).

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40
Q

What does a score of 0 indicate for muscle tone in the Apgar score?

A

A score of 0 indicates limp muscle tone.
score of 1- some flexion
score of 2- active movement

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41
Q

response to stimuli grading

A

1- none
2- weak movement
3- cry

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42
Q

grading of colour

A

0- blue or pale
1- body pink, extremities blue
2- completely pink

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43
Q

grading of resp. effort

A

0- absent
1- weak/irregular
2- strong/ regular

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44
Q

When is the Apgar score typically assessed after birth?

A

The Apgar score is typically assessed at 1 minute after birth, and if needed, repeated at 5 minutes.

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45
Q

What is considered a normal Apgar score range?

A

A normal Apgar score range is 7-10.

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46
Q

What Apgar score range indicates a moderately abnormal condition?

A

A moderately abnormal condition is indicated by an Apgar score range of 4-6.

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47
Q

How is a severely abnormal condition classified based on the Apgar score?

A

A severely abnormal condition is indicated by an Apgar score range of 0-3.

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48
Q

What does a low Apgar score (below 7) at 1 minute confirm?

A

It confirms the need for resuscitation.

49
Q

What is the expected Apgar score range after adequate resuscitation by 5 minutes?

A

The expected range is a normal score of 7 or above.

50
Q

What does a low Apgar score at 5 minutes, especially at 10 minutes, suggest?

A

It suggests significant intrapartum hypoxia or severe respiratory distress.

51
Q

What does the duration of a low Apgar score indicate about the infant’s likelihood of survival?

A

The longer the score remains low, the greater the likelihood that the infant will die.

52
Q

Why is a score of 10 at 1 minute considered rare?

A

It’s rare because all newborn infants typically have peripheral cyanosis at birth.

53
Q

What is the primary cause of neonatal cardiac arrest?

A

Neonatal cardiac arrest is primarily due to hypoxia.

54
Q

What remains the focus of initial resuscitation in cases of neonatal cardiac arrest?

A

The focus remains on the initiation of ventilation.

55
Q

What equipment should all delivery centers have for neonatal resuscitation?

A

They should have adequate resuscitation equipment in working order, including a good overhead light source and means of keeping the infant warm.

56
Q

What is essential for all medical and nursing staff delivering infants?

A

They should be able to perform basic resuscitation.

57
Q

What is the aim of resuscitation if infants do not breathe well after birth?

A

The aim is to establish breathing within one minute of birth, known as the ‘golden minute.’

58
Q

Why is it important to document the timing and response to each step in the resuscitation process?

A

Documentation helps track the effectiveness of interventions and guides further actions as needed.

59
Q

Steps to resuscitate a newborn infant

A

*Good drying to stimulate breathing and preventing hypothermia
*Airways
*Breathing
*Circulation
*Drugs
*Post Resuscitation Care
*Delayed cord clamping

60
Q

What is the purpose of good drying immediately after delivery for all infants?

A

Good drying stimulates the onset of breathing in approximately 80% of infants.

61
Q

What action should be taken if an infant does not breathe well or cry after drying?

A

Resuscitation is needed if the infant does not breathe well or cry after drying.

62
Q

How can gentle stimulation be provided to an infant who does not breathe well after drying?

A

Gently rubbing the infant’s back once or twice is a good way to provide stimulation. Smacking, shaking, or flicking the feet should not be done.

63
Q

How should term and late preterm infants be kept warm during the transition period after birth?

A

Term and late preterm infants should be kept warm to prevent hypothermia during the transition period by drying well and maintaining a warm environment.

64
Q

What method is recommended for maintaining body temperature in preterm infants less than 30 weeks gestation or weighing less than 1200g?

A

These infants should be placed directly into a clean food-grade plastic bag (feet first) without drying, with holes cut out to expose the umbilicus or limbs if necessary, and resuscitated through the bag.

65
Q

When should the plastic bag be removed from preterm infants stabilized in an incubator?

A

The plastic bag should only be removed once the infant is stabilized in the incubator.

66
Q

What format do the steps to resuscitate an infant after birth follow?

A

The steps follow the ABCD format: Airway, Breathing, Circulation, Drugs.

67
Q

When is routine suctioning of the airways contraindicated in neonatal resuscitation?

A

Routine suctioning of the airways is contraindicated unless the infant is born through meconium-stained amniotic fluid and needs resuscitation.

68
Q

What action should be taken if an infant breathes well after birth?

A

If the infant breathes well, no further suctioning of the airways is needed.

69
Q

What is the next step if an infant does not breathe after being dried?

A

If the infant does not breathe after being dried, some form of artificial ventilation is required.

70
Q

What is the simplest method of artificial ventilation for a non-breathing infant?

A

The simplest method is mask ventilation using a resuscitator (mask and self-inflating bag) with the mask applied tightly to the infant’s face or a T-piece with 5 cm PEEP.

71
Q

How should the infant’s head be positioned during mask ventilation?

A

The head should be positioned in the neutral ‘sniffing position’ with the face forward and the neck not hyper-extended.

72
Q

What should be ensured during mask ventilation to confirm effective ventilation?

A

Mask ventilation must produce good chest movement. If not, it indicates incorrect mask application or a blocked airway.

73
Q

What should be checked to ensure the airway is not blocked during mask ventilation?

A

Ensure the infant’s head is in the correct position and the airways are not blocked with secretions, meconium, or blood.

74
Q

What should be done after 30 seconds of effective mask ventilation?

A

After 30 seconds, palpate the base of the umbilical cord or listen to the chest for heart sounds.

75
Q

What should be the course of action if the pulse is good (above 100/minute)?

A

If the pulse is good, continue ventilating until breathing starts.

76
Q

What should be done if the pulse is slow?

A

If the pulse is slow, reposition the mask and ensure good air entry with mask ventilation.

77
Q

What should be considered if bradycardia persists after a further 30 seconds of mask ventilation?

A

Consider endotracheal intubation, particularly if skilled in intubation.

78
Q

What size endotracheal tube is typically used for neonatal intubation?

A

A 2.5 or 3.0 mm straight endotracheal tube is commonly used.

79
Q

What equipment is used for endotracheal intubation?

A

A laryngoscope with a size ‘0’ straight blade is typically used for endotracheal intubation.

80
Q

How can the ventilation bag be connected after endotracheal intubation?

A

The ventilation bag can be connected to the endotracheal tube after intubation.

81
Q

What is the recommended ventilation rate after endotracheal intubation?

A

A ventilation rate of 30-40 breaths per minute is recommended.

82
Q

When is the use of continuous positive airway pressure (CPAP) encouraged?

A

CPAP is encouraged if ongoing respiratory distress is evident after the golden minute in a spontaneously breathing infant.

83
Q

What influences the time it takes for an infant to start breathing spontaneously after birth?

A

The severity of fetal hypoxia influences the time it takes for the infant to start breathing spontaneously.

84
Q

When should supplemental oxygen be administered during neonatal resuscitation?

A

Supplemental oxygen should only be given if the pulse remains slow despite good ventilation in room air.

85
Q

What tool is helpful in measuring heart rate and oxygen saturation during complicated resuscitation?

A

The use of a pulse oximeter is very useful in measuring heart rate and oxygen saturation during complicated resuscitation.

86
Q

What are the typical oxygen saturation levels in well infants that breathe room air spontaneously?

A

Oxygen saturations of 60% at birth steadily increase to 85% at 5 minutes in well infants breathing room air spontaneously.

87
Q

What are the normal pre-ductal oxygen saturation levels at various time points after birth?

A

At 1 minute: > 60%
At 2 minutes: > 65%
At 3 minutes: > 70%
At 4 minutes: > 75%
At 5 minutes: > 80%
After 10 minutes: 90 - 95%

88
Q

What is the recommendation regarding the use of supplementary oxygen in term infants during resuscitation?

A

Most term infants can be adequately resuscitated in room air to avoid potential damage to the brain caused by free radicals released by supplementary oxygen.

89
Q

What is the concern regarding supplementary oxygen in term infants during resuscitation?

A

Supplementary oxygen may induce the release of free radicals, potentially damaging the brain.

90
Q

What is the recommended oxygen supplementation for preterm infants requiring resuscitation?

A

Initiate with 30-40% oxygen and titrate to achieve a preductal oxygen saturation of 88-92%.

91
Q

What is the target preductal oxygen saturation for preterm infants during resuscitation?

A

The target preductal oxygen saturation for preterm infants is 88-92%.

92
Q

Why is it recommended to avoid supplementary oxygen in most term infants during resuscitation?

A

To prevent potential brain damage caused by free radicals released by supplementary oxygen.

93
Q

What is the suggested oxygen concentration for initial resuscitation of preterm infants according to the Resuscitation Council of Southern Africa?

A

The suggested oxygen concentration for initial resuscitation of preterm infants is 30-40%.

94
Q

How should the oxygen concentration be adjusted during resuscitation of preterm infants?

A

It should be titrated to achieve a preductal oxygen saturation of 88-92%.

95
Q

How is the pulse rate typically measured in neonatal resuscitation?

A

The pulse rate is measured by palpating the base of the umbilical cord or auscultating the heart.

96
Q

What is the normal pulse rate that indicates adequate ventilation?

A

A pulse rate above 100 per minute is considered normal and indicates adequate ventilation

97
Q

Why are peripheral pulses often difficult to feel in neonatal resuscitation?

A

Peripheral pulses are often difficult to feel due to the small size of neonates and their delicate vasculature.

98
Q

What does a persistent heart rate below 100 per minute indicate during neonatal resuscitation?

A

A persistent heart rate below 100 per minute is a good marker for inadequate ventilation.

99
Q

When should external cardiac compressions be initiated during neonatal resuscitation?

A

External cardiac compressions should be initiated if the heart rate remains below 60 beats per minute.

100
Q

What is the recommended rate for external cardiac compressions?

A

External cardiac compressions should be performed at approximately 120 times per minute.

101
Q

What compression-to-ventilation ratio is used during neonatal resuscitation?

A

A ratio of 3 sternal compressions to 1 breath (3:1) is used.

102
Q

Where should the sternum be depressed during external cardiac compressions?

A

The sternum should be depressed at a point 1cm below a line joining the nipples, well above the xiphi-sternum.

103
Q

What technique is recommended for external cardiac compressions?

A

A two-handed technique with the palms and fingers behind the infant’s back while depressing the lower sternum with the thumbs to a depth of approximately 1/3 of the AP diameter is recommended.

104
Q

What are indicators of adequate circulation during cardiac massage?

A

Pink peripheries with rapid capillary filling when the skin over the chest is pressed are good indications of adequate circulation.

105
Q

How often are drugs typically needed during neonatal resuscitation?

A

Drugs are needed in approximately 1 in 1000 infants during resuscitation.

106
Q

What is the recommended dose of adrenaline during neonatal resuscitation?

A

Adrenaline is typically administered at a dose of 0.1 ml/kg of a 1:10 000 solution.

107
Q

How can adrenaline be administered if an intravenous line cannot be started?

A

If an intravenous line cannot be started, adrenaline can be administered via the endotracheal tube at a dose of 0.25 ml/kg.

108
Q

How is the adrenaline solution prepared for intravenous administration?

A

The adrenaline solution for intravenous administration is prepared by diluting 1 ml of adrenaline 1:1000 in 9 ml of saline or sterile water to achieve a 1:10 000 solution.

109
Q

What is the controversy surrounding the use of sodium bicarbonate during neonatal resuscitation?

A

The use of sodium bicarbonate is controversial in neonatal resuscitation.

110
Q

What is an important precaution when administering sodium bicarbonate during resuscitation?

A

Sodium bicarbonate should never be given down the endotracheal tube.

111
Q

What should be checked if an infant fails to respond to resuscitation?

A

The blood glucose concentration should be checked.

112
Q

What is the threshold for administering dextrose water intravenously during neonatal resuscitation?

A

If the blood glucose concentration is below 1.5 mmol/l (25 mg %), 5 ml of 10% dextrose water should be given slowly intravenously.

113
Q

What is the recommended fluid therapy for infants with low blood glucose concentrations during resuscitation?

A

Infants with low blood glucose concentrations should receive a continuous intravenous infusion containing 10% dextrose at a rate of 60 ml/kg/day after initial dextrose administration.

114
Q

What should be administered if the infant appears exsanguinated during resuscitation?

A

If the infant appears exsanguinated, 20 ml/kg of normal saline or emergency O negative blood should be given.

115
Q

Is there a role for atropine or calcium in neonatal resuscitation?

A

No, there is no role for atropine or calcium in neonatal resuscitation.

116
Q

What is the effect of naloxone in neonatal resuscitation?

A

Naloxone reverses the respiratory depressing effects of opiate analgesics given to the mother within 4 hours of delivery.

117
Q

What is the recommended route and dosage of naloxone in neonatal resuscitation?

A

Routine naloxone (Narcan) 0.25 ml/kg IM/IV (0.1 mg/kg) is not recommended.

118
Q

Why is routine naloxone not recommended in neonatal resuscitation?

A

Evidence showed no difference in outcomes compared to ventilation.

119
Q

How long may it take for IM naloxone to act?

A

IM naloxone may take a few minutes to act.

120
Q

What are important aspects of post-resuscitation care for neonates?

A

Post-resuscitation care includes maintaining normothermia and appropriate oxygen saturations.

121
Q

What should be done if resuscitation has been prolonged or difficult?

A

If resuscitation has been prolonged or difficult, the infant should be transferred to the nursery for observation and further assessment.

122
Q

When should further attempts at resuscitation be considered hopeless?

A

If there is no heartbeat after 10 minutes or if bradycardia with no adequate respiratory efforts persists after 20 minutes despite aggressive resuscitation, further attempts at resuscitation are probably hopeless.

123
Q

What is the recommended approach for cord clamping in term and preterm infants who do not require resuscitation at birth?

A

Delayed cord clamping for 30-120 seconds is recommended.

124
Q

What is still being investigated regarding cord clamping in infants who need resuscitation?

A

The possible advantages and disadvantages of cord “milking or stripping” rather than delayed cord clamping are still being investigated in infants who need resuscitation.

Neonate (34 decks)

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