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Nenonate > Test 2 - Neonatal Resuscitation > Flashcards

Test 2 - Neonatal Resuscitation Flashcards

1
Q

How long can a fetus compensate for in the fetal hypoxia termed fetal stress?**

A

Fetus can compensate for up to 45 minutes of fetal hypoxia termed fetal stress**

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2
Q

How does uteroplacental blood flow produces fetal asphayxia?

A

Any compromise of uteroplacental blood flow produces fetal asphyxia

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3
Q

What is the most common cause of neonatal depression, when it comes to fetal resuscitation?

A

Intrauterine asphyxia is the most common cause of neonatal depression

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4
Q

What is the most important and helpful in identifying distress throughout labor?

A

Fetal monitoring throughout labor is important and helpful in identifying distress

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5
Q

What is the % of false positive rate when it comes to fetal monitoring

A

Alone it has a 35-50% false positive rate

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6
Q

How many weeks are required before starting fetal monitoring on a patient?

A

Required at 24 weeks and above

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7
Q

What are the several parameters that fetal heart rate monitoring must have?

A

Baseline heart rate

Baseline variability

Relationship to uterine contractions
-Deceleration patterns

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8
Q

What is normal fetal baseline heart rate?

A

Normal – 110-160 beats/min

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9
Q

What are some things that can increase fetal heart rate above normal?

A
  • Prematurity
  • Mild fetal hypoxia
  • Chorioamnionitis (infection of the placenta, from pre mature rupture)
  • Maternal fever
  • Maternally administered drugs (anticholinergics or beta agonists)
  • hypothyroid
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10
Q

What are some things that can decrease fetal heart rate below normal?

A
  • Post-term pregnancy
  • Fetal heart block
  • Fetal asphyxia
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11
Q

What is the single MOST important characteristic of FHR?

A

Variability

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12
Q

What does variability represent in terms of the fetal neuro status?

A

Reflects an intact neurological system

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13
Q

What does variability represent in terms of fetal oxygenation?

A

Represents optimal fetal oxygenation

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14
Q

Variability measures fetal oxygenation (BLACK)

A

Measure of fetal oxygenation RESERVE

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15
Q

How is baseline variability best assessed by?

A

Best assessed by scalp electrodes

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16
Q

What is a prominent sign of fetal asphyxia?

A

Sustained decreased baseline variability is a prominent sign of fetal asphyxia

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17
Q

What are some causes of decrease variability for a fetus?

A
  • CNS depressants (opioids, barbiturates, Mg sulfate, benzos)
  • Parasympatholytics (atropine) (decrease the fluctuations)
  • Prematurity
  • Fetal dysrhythmias
  • Anecephaly
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18
Q

Normal fetus displays beat to beat variablity (R wave to R wave), what is defined as a minimal?

A

minimal of <5 beats per minute

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19
Q

Normal fetus displays beat to beat variablity (R wave to R wave), what is defined as moderate?

A

moderate 6-25 beats/min

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20
Q

Normal fetus displays beat to beat variablity (R wave to R wave), what is defined as a marked?

A

marked >25 beats/min

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21
Q

Sinusoidal (mathematical curve that describes a smooth periodic oscillation) pattern is associated with fetal depression, what are three causes?

A

Hypoxia
Drugs
Anemia

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22
Q

Accelerations are defined as?

A

Defined as increases of 15 beats/min or more lasting more than 15 seconds

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23
Q

Periodic increases reflect normal oxygenation and are usually related to what two things?

A

Periodic increases reflect normal oxygenation and are usually related to fetal movement and responses to uterine pressure

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24
Q

Normal fetuses have how many accelerations q hour?

A

Normal fetuses have 15-40 accelerations q hour

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25
Q

The amount of accelerations can decrease q hour, what are some causes?

A
  • Fetal sleep
  • Drugs (opioids, mg, atropine)
  • Hypoxia
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26
Q

THE ABSENSE OF BOTH BASELINE VARIABILTY AND ACCELERATIONS IS “BLANK” AND MAY BE AN IMPORTANT SIGN OF FETAL COMPROMISE****

A

THE ABSENSE OF BOTH BASELINE VARIABILTY AND ACCELERATIONS IS “NONREASSURING” AND MAY BE AN IMPORTANT SIGN OF FETAL COMPROMISE****

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27
Q

What is the response that causes an early deceleration?

A
  • Early (type I) deceleration are thought to be a response to compression of the fetal head or stretching of the neck during uterine contractions
  • Generally not associated with distress
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28
Q

What is associated with late deceleration?*

A

Late (type II)
-Associated with fetal compromise
-Occur at the peak or following the contraction
BAD***

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29
Q

What is thought to cause a variable deceleration?

A

Variable (type III)

  • Most common
  • Thought to be from cord compression and intermittent decreases in umbilical blood flow
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30
Q

What is considered prolonged deceleration patterns?

A

Associated with fetal asphyxia when they are >60 bpm, last longer than 60 seconds or occur in a pattern that persists for more than 30 minutes

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31
Q

How is the fetal scalp pH obtained?

A

Fetal scalp pH – obtained by making a small puncture in neonate’s scalp and obtaining blood

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32
Q

What pH is considered vigorous or depressed neonate?

A

> 7.20 associated with vigorous neonate

<7.20 associated with a depressed neonate

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33
Q

When does breathing normally begin for a neonatal patient?

A

Breathing normally begins 30 seconds and is sustained with 90 seconds

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34
Q

What is normal breaths per minute for a neonate?

A

Normal 30-60 breaths per minute

35
Q

What is normal heart rate for a neonate?

A

Normal heart rate is 120-160 beats per minute

36
Q

What is normal BP for a neonate that weighs 1-2kg?

A

50/25 for neonates 1-2kg

37
Q

What is normal BP for a neonate that weighs more than 3kg?

A

70/40 for >3 kg

38
Q

When should you do an APGAR score to test for survival and neurological outcome?

A

APGAR scores at 1 (survival) and 5 (neurological outcome) minutes after delivery

39
Q

What are the four causes of persistent pulmonary hypertension?**

A

Acidosis
Hypoxia
Hypovolemia
Hypothermia

40
Q

What is the time span for a neonate?

A

Neonate is 1-28 days**

41
Q

What will stimulate the release of surfactant into the alveoli? When the patient goes from intrauterine to extrauterine?

A

Lung inflation will stimulate release of surfactant into the alveoli

42
Q

What causes the transient tachypnea of the newborn when it transitions from intrauterine to extrauterine?

A

Caused by retained fluid in the lungs

43
Q

How much fluid does the fetal lung contain when it transition from intrauterine to extrauterine?

A

The fetal ling contains fluid 30mL/kg

44
Q

During birth, how much fluid is expelled from the lungs in a neonate during delivery?

A

2/3 expelled from the lungs during delivery

45
Q

During birth, how much fluid is expelled form the lungs in a preterm or delivery through c-section?

A

Preterm babies and those delivered by C/S will have increased residual lung fluid

46
Q

During the transition from intrauterine to extrauterine life, what happens in response of the catecholamine surge?

A
  • Allows for release of surfactant
  • Directs flow to vital organs during delivery
  • Thermoregulation
47
Q

During the transition from intrauterine to extrauterine life, a wet baby will loose heat by:

A

Conduction
Convection
Evaporation
Radiation

48
Q

What causes neonatal depression?

A
  • Drugs given to mother (anesthetics, opioids, sedatives, and magnesium)
  • Intrauterine fetal hypoxia and acidosis
  • High or low environmental temperature
  • CNS trauma caused by birth process
  • Congenital anomalies
49
Q

What does APGAR stand for?

A 
Appearance
Pulse rate
Grimace
Activity
Respiration
50
Q

What is a mildly asphyxiated apgar score?

A

Mildly asphyxiated score 5-7

-Need stimulation while 100% O2 blown across face

51
Q

What is a moderate asphyxiation apgar score?

A

Moderate asphyxiation score 3-4

-Require temporary assisted positive pressure ventilation with mask and bag

52
Q

What is a severe depression apgar score?

A

Severe depression score 0-2 (not good)

-Immediate intubation and chest compressions may be required

53
Q

Umbilical cord gas and pH analysis reflects the fetal condition immediately before delivery, What does the umbilical artery blood gas represent and what does the umbilical vein reflect?

A

Umbilical artery blood gas represents the fetal condition

Umbilical vein reflects the maternal condition and uteroplacental gas exchange

54
Q

What is normal umbilical cord pH?

A

Normal umbilical cord pH >7.2

Presence of metabolic acidosis is a more ominous sign than respiratory acidosis

55
Q

Normal arterial values for umbilical cord blood? (pH Pco2 and bicarb)

A

Arterial
pH 7.28
Pco2 49.2
Bicarb 22.3

56
Q

Normal venous values for umbilical cord blood? (pH Pco2 and bicarb)

A

Venous
pH 7.35
Pco2 38.2
Bicarb 20.4

57
Q

Where should you place the pulse oximeter to evaluate the pre-ductal blood flow in a neonate?

A

Place the pulse oximeter on the right upper extremity for:
-Pre-ductal blood flow
-Accurate assessment of -CNS oxygenation
Place over the right radial artery

58
Q

For neonatal resuscitation, how much of an increase in HR is a reliable sign of effective oxygenation?

A

An increase in HR above 100 is a reliable sign of effective oxygenation

59
Q

Many infants have respiratory depression caused by opioids given to the mom, what is the dose for Nalaxone?

A

Nalaxone 0.1mg/kg IV, ET, IO, SQ

60
Q

For neonatal resuscitation, if positive pressure ventilation does not improve oxygenation, what should you do?

A

Insert an ETT

After intubation resume positive pressure ventilation with 100% O2 until the infant is stable
-FiO2 should be reduced as soon as possible

61
Q

Chest compressions are preformed when the HR is below what (#) for neonatal resuscitation?

A 
HR is below 60.
-Ventialtion ratio 3:1
-Rate is 90 per minute
Stop compressions when -HR is above 60
-Continue ventilations until HR is above 100
62
Q

For neonatal resuscitation, if baby is experiencing hypovolemia, how much should you give?

A

NS or LR 10mL/kg over 5-10 mins

63
Q

For neonatal resuscitation, what drug is the treatment of choice for bradycardia?

A

Epinephrine

  • used if HR is <60bpm after 30 sec of ventilation and chest compression
  • repeat every 3-5min
64
Q

For neonatal resuscitation, what drug should you give after a prolonged resuscitation? (this drug is guided by blood gas)

A

Sodium Bicarbonate

65
Q

Meconium in amniotic fluid occurs in what % of deliveries?

A

10-12% of deliveries

66
Q

Fetal distress (especially after 42 weeks gestation) is often associated with a release of what into fluid? (for a neonate)

A

Associated with a release of thick meconium into fluid

67
Q

Neonatal gasping causes the thick fluid to enter the lungs (from trachea to large airways to periphery of lungs), what is the % that severe respiratory distress can occur and what can these infants further develop?

A
  • Severe respiratory distress in 15%

- Even worse these infants can develop persistent fetal circulation

68
Q

What is the treatment for meconium stained neonates?

A
  • Amnioinfusion prior to delivery can reduce severity
  • Bulb suctioning recommended for thin watery meconium
  • Intubation and tracheal suction considered if thick meconium present
  • -3x tracheal suctioning and ETT removed then supplimental O2 with tight fitting mask
69
Q

What are signs of magnesium intoxication? for neonates?

A

Hypotension, hypotonic, and peripherally dilated

  • may require intubation and mechanical ventilation
  • Mg will decrease over 24-72 hours
  • antidote: Calcium
70
Q

What is the most common metabolic problem in neonates?

A

Hypoglycemia

71
Q

What is considered the parameter for hypoglycemia in neonates?

A

When BS is below 45mg/dL in the first 3 days of life

-after 3 days, normal BS is greater than 75-90 mg/dL

72
Q

Neurologic damage can occur if hypoglycemia is not treated, what are some signs?

A

Lethargy, apnea, cyanosis, seizures, and hypotonia

73
Q

What are some causes of hypoglycemia for a neonate?

A

Hypoxemia, sepsis, and high levels of circulating insuline

74
Q

For newborn charateristics, cardiac output is dependent on heart rate, why?*

A

Because stroke volume is relatively fixed

  • noncompliant LV
  • Poorly developed LV

(faster HR)

75
Q

What are some newborn characteristics for pulmonary status?*

A
  • Lower lung compliance
  • Greater chest wall compliance
  • Lower FRC
76
Q

For new borns, what must you do to blood products??**

A

Cellular blood products must be irradiated to reduce the increase risk of transfusion-associated graft versus host disease(GVHD)

77
Q

For newborns, what is different about the body surface area and total body water content?*

A
  • Higher ratio of body surface area to body weight

- Higher total body water content

78
Q

For newborns, what is different about the tongue, head, nasal passages?*

A
  • Large tongue and head
  • Narrow nasal passages
  • Anterior and cephalad larynx
79
Q

For newborns, what is different about the epilgottis, trachea, neck, tonsils and adenoids?*

A
  • Long epiglottis
  • Short trachea and neck
  • Prominent tonsils and adenoids
80
Q

For newborns, what is different about the intercostal and diaphragm muscles, and resistance to airflow?*

A
  • Weak intercostals and diaphragm muscles

- High resistance to airflow

81
Q

What is considered newborn or a neonate?*

A

Newborn first 28 days of life.

82
Q

Why do neonates experience respiratory fatigue faster?**

A
  • The diaphragm has more type II (fast twitch) and less type I fibers (slow twitch)***
  • Neonatal diaphragm only has 25% type 1 (adults have 55%). Preterm babies have less than 10%**
83
Q

What is the difference between type I and type II fibers?**

A
  • Type 1 are built for endurance- they are resistant to fatigue
  • Type 2 are built for short bursts of heavy work- they tire easily

Nenonate (2 decks)

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