The Delivery Room Flashcards
What are the 5 components of an Apgar score?
Heart rate, respiration, muscle tone, reflex irritability, and color.
How do you score the heart rate component of the Apgar score?
0 = absent, 1 = <100 bpm, 2 = >100 bpm
How do you score the respiration component of the Apgar score?
0 = absent, 1 = slow and irregular, 2 = good, crying
How do you score the muscle tone component of the Apgar score?
0 = Limp, 1 = some flexion, 2 = active motion
How do you score the reflex irritability component of the Apgar score?
0 = No response, 1 = Grimace, 2 = cough/sneeze/cry
How do you score the color component of the Apgar score?
0 = Blue/pale, 1 = Body pink/limbs blue, 2 = Completely pink
Can a self-inflating bag be used to deliver free-flowing oxygen?
No. Nor can it be used to deliver CPAP.
What is the current recommendation for cord clamping following delivery?
If the infant is stable, cord clamping should be delayed 30-60 seconds. If unstable, clamp the cord and proceed with resuscitation.
What is the best value at which to keep the PaO2 in the term newborn?
50-70 mmHg
What are the target preductal SpO2 values during the first 10 minutes following an uncomplicated birth at term?
*** Table 1-7
What initial inflation pressure and respiratory rates should be utilized if a neonate requires bag-mask ventilation in the delivery room?
Initial inflation pressures should be 20-25 cm H2O with a rate of 40-60 breaths per minute.
What is the most important indicator of successful positive-pressure ventilation during newborn resuscitation?
Increasing heart rate is the most important indicator of successful positive-pressure ventilation during resuscitation.
What are the weight cut-offs for determining which ET tube diameter to use in a neonate?
<1kg: 2.5 mm; 1-2kg: 3 mm; >2kg: 3.5mm
What are the weight cut-offs for determining which ET tube length to use in a neonate? What is a formula one can use to remember this rule?
1kg: 7 cm; 2kg: 8 cm; 3kg: 9 cm; 4kg: 10 cm. An easy formula for remembering this is: 6 + weight in kg.
What ET tube size should be used in a 1 kg infant?
2.5 mm x 7 cm
What ET tube size should be used in a 2 kg infant?
3 mm x 8 cm
What ET tube size should be used in a 3 kg infant?
3.5 mm x 9 cm
What ET tube size should be used in a 4 kg infant?
3.5 mm x 10 cm
At what point should cardiac compressions be initiated in a neonate?
If the HR is <60, after adequate ventilation, initiate external cardiac compressions.
At what rate and ratio should compressions and ventilations be maintained during resuscitation of a neonate?
3:1 compressions to ventilations, with 90 compressions and 30 breaths to achieve approximately 120 events/minute.
What does epinephrine do to the heart in a code situation?
Stimulates α-adrenergic receptors, enhances cardiac contractility, constricts the peripheral circulation, has β-adrenergic effects on the receptors of the heart, and increases the rate and effectiveness of cardiac contraction.
What is the dose of epinephrine for neonates?
0.01 - 0.03 mg/kg (0.1-0.3 ml/kg) of 1:10,000 solution via IV (preferred) or endotracheal
What is the most likely cause of bradycardia in the neonate during a code situation?
Ineffective bag-mask ventilation, esophageal intubation, or airway obstruction.
Which neonatal resuscitation drug can be given via the endotracheal tube?
Epinephrine
What is the best site for emergency intravascular access at birth?
Umbilical vein.
Which drug, at what dose, can you give if you suspect the child is sedated due to maternal anesthetics or narcotics?
Naloxone at a dose of 0.1 mg/kg IM or IV, repeated as necessary.
In what situation would one avoid the use of Naloxone in an infant exposed to maternal opiates?
If the mother had chronic opiate use, one should avoid giving the neonate naloxone because of the risk for precipitating acute withdrawal or seizures.
How does the neonate’s surface area-to-body weight ratio compare to that of an adult?
The ratio is 3x higher in the neonate.
What is the optimal delivery room temperature?
Between 73° and 76° F (23-24° C)
At what gestational age would you consider using plastic to prevent heat loss in the preterm infant?
Infants <29 weeks of gestation should be placed in a clean, clear plastic bag up to the neck after delivery to minimize heat loss.
What Apgar score, at what time, is indicative of high rates of mortality and permanent neurologic sequelae?
The scores recorded at 1 and 5 minutes of life have no correlation to long term outcomes. However, a score of <3 at 15 minutes of life has been associated with >50% mortality and >60% permanent, severe neurologic sequelae in infants who survive.
