Resuscitation in the Delivery Room

Question 1

the fetal level of The partial pressure of oxygen (PO2) approximately…?

Answer 1

25 mm Hg

Question 2

What is primary apnea …?.?

Answer 2

Fetuses initially respond to brief hypoxia by irregular respirations and apnea

Question 3

What is secondary apnea…?

Answer 3

If the period of hypoxia continues, the fetus will irregularly gasp and lapse into secondary apnea

Question 4

What is being central to resuscitation …?

Answer 4

establishing ventilation

Question 5

Targeted preductal SpO2 after birth….?

Answer 5

1 minute. 60%–65%
2 minutes. 65%–70%
3 minutes 70%–75%
4 minutes 75%–80%
5 minutes 80%–85%
10 minutes 85%–95%

Question 6

Suction catheter size for resuscitation ….?

Answer 6

Suction catheter 10 and 12 F and wall suction <100 mm Hg

Question 7

While doing PPV flow rate of O2…?

Answer 7

Flow meter set at 10 L/minut

Question 8

oxygen source and set blender in term and preterm ….?

Answer 8

room air for a term infant and

up to 30% for a preterm infant;

flow is set as per manufacturer’s recommendation for the T-piece resuscitator (10 L/minute)

Question 9

T-piece resuscitator setting for PPV …?

Answer 9

positive end-expiratory pressure (PEEP) of 5 to 6 and

peak inspiratory pressure (PIP) of 20 to 25 mm Hg

Question 10

laryngoscope size ….?

Answer 10

no. 1 for full-term neonates,

no. 0 for premature neonates,

no. 00 for extremely low-birth-weight neonates

Question 11

ET tube for the expected birth weight …?

Answer 11

3.5 mm for fullterm infants,

3.0 mm for premature infants >1,250 g, and

2.5 mm for extreme preterm infants

Question 12

Delayed cord clamping……?

Answer 12

If the infant is breathing spontaneously at birth, the cord should not be clamped and divided until at least 30 to 60 seconds have passed

Question 13

Rapid assessment at birth……..?

Answer 13

■ Is the baby term?

■ Is the tone good?

■ Is the baby breathing or crying?

Question 14

When to consider baby in secondary apnea….?

Answer 14

If breathing does not start after two attempts at tactile stimulation, the baby should be considered to be in secondary apnea

Question 15

How to do Tactile stimulation …?

Answer 15

Tactile stimulation by tapping the sole or rubbing the back gently may help initiate breathing

Question 16

Oxygen concentration should be increased to 100% during resuscitation when …?

Answer 16

if bradycardia (heart rate <60 bpm) does not improve after 90 seconds of resuscitation.

Question 17

Indications for PPV are…..?

Answer 17

■ The infant is apneic/gasping despite tactile stimulation.

■ The infant has a heart rate of <100 bpm despite apparent respiratory effort.

Question 18

Apnea with bradycardia represents what …..?

Answer 18

secondary apnea and

requires treatment with PPV

Question 19

When indicated, PPV must be started within how many minutes ….?

Answer 19

1 minute of birth.

Question 20

In infants with normal lungs, this inspiratory pressure is usually no more than…..?

Answer 20

15 to 20 cm H2O

Question 21

The most important indicator of adequate ventilation is a….?

Answer 21

rise in the heart rate.

Question 22

The first assessment after initiation of PPV should be at….
.?

Answer 22

15 seconds

Question 23

What to do In case of poor chest rise at 15 seconds…..?

Answer 23

MRSOPA is used to optimize ventilation

Question 24

MRSOPA….?

Answer 24

■ M—mask adjustment
■ R—reposition infant
■ S—suction airway
■ O—open airway
■ P—pressure to be increased
■ A—alternate airway (intubation)

Question 25

What to after successfull PPV ….?

Answer 25

If the baby’s heart rate is >100/minute and he/she has good tone and respiratory efforts,

-one may decrease rates and pressure of PPV
-provide oxygen or CPAP for a while, and observe.

Question 26

How to do intubation …?

Answer 26

the baby’s chin, sternum, and umbilicus are all lined up in a single plane and if, after insertion into the infant’s mouth, the laryngoscope handle and blade are aligned in that plane and lifted vertically at an approximately 60° angle to the baby’s chest, only one of four anatomic landmarks will be visible to the intubator

Question 27

The depth of insertion of an ET tube is given by the formula …?

Answer 27

NTL + 1, where NTL denotes the nasotragal length

The nasotragal length is measured from the columella to the tragus

Question 28

One must complete the intubation in within how many seconds …?

Answer 28

30 seconds

Question 29

Laryngeal masks are easy to insert and are effective for ventilating newborns weighing…..?

Answer 29

> 2,000 g.

Question 30

The best technique Chest compression ..?

Answer 30

The best technique is to encircle the chest with both hands, placing the thumbs together over the lower third of the sternum, with the fingers wrapped around and supporting the back.

Compress the sternum about one-third of the antero-posterior diameter of the chest

at a rate of 90 times per minute in a ratio of three compressions for each breath

Question 31

After how many seconds of chest compression and PPV, briefly stop chest compression and check the heart rate

Answer 31

60 sec

Question 32

When to consider for epinephrine …?

Answer 32

If no improvement is noted and the heart rate remains below 60 bpm, compression and ventilation should be continued. Epinephrine should be considered.

Question 33

Indication for epinephrine …?

Answer 33

If the heart rate of the baby remains <60 bpm despite adequate ventilation with 100% oxygen (for 30 seconds) and chest compressions (60 seconds),

epinephrine (1:10,000, 0.1 mg/mL) should be given

Question 34

The recommended dose of IV epinephrine…?

Answer 34

0.1 to 0.3 mL/kg (up to 1.0 mL) of a 1:10,000 epinephrine solution should ideally be given through the umbilical venous catheter and flushed with 3 mL normal saline into the central circulation

Question 35

The intratracheal route of administration may be considered while IV access is being established, using doses of ..?

Answer 35

0.5 to 1.0 mL/kg of 1:10,000 dilution (0.05 to 0.10 mg/kg).

Question 36

Combined Apgar …?

Answer 36

CPAP,
Oxygen,
Mask and Bag,
Intubation,
Neonatal chest compressions,
Exogenous surfactant, and
Drugs

Question 37

Combined Apgar interpretation …?

Answer 37

Each intervention is scored 0 (if performed) and 1 (if not performed).

This is taken in combination with the above-specified Apgar score, and a score <10/17 is an indicator for high morbidity/mortality.

Question 38

When to call newborn as vigorous, in MSAF …?

Answer 38

defined by strong respiratory effort,

good muscle tone, and a

heart rate >100 bpm

Question 39

Delivery room resuscitation temperature ?..?

Answer 39

Set room temperature to 23°C to 25°C

Question 40

When to consider for discontinuation of resuscitation ..?

Answer 40

If there are no signs of life in an infant after 10 to 20 minutes (2020 guidelines) of aggressive resuscitative efforts, with no evidence of correctible factors, discontinuation of resuscitation efforts may be considered