The Delivery Room

Question 1

What are the 5 components of an Apgar score?

Answer 1

Heart rate, respiration, muscle tone, reflex irritability, and color.

Question 2

How do you score the heart rate component of the Apgar score?

Answer 2

0 = absent, 1 = <100 bpm, 2 = >100 bpm

Question 3

How do you score the respiration component of the Apgar score?

Answer 3

0 = absent, 1 = slow and irregular, 2 = good, crying

Question 4

How do you score the muscle tone component of the Apgar score?

Answer 4

0 = Limp, 1 = some flexion, 2 = active motion

Question 5

How do you score the reflex irritability component of the Apgar score?

Answer 5

0 = No response, 1 = Grimace, 2 = cough/sneeze/cry

Question 6

How do you score the color component of the Apgar score?

Answer 6

0 = Blue/pale, 1 = Body pink/limbs blue, 2 = Completely pink

Question 7

Can a self-inflating bag be used to deliver free-flowing oxygen?

Answer 7

No. Nor can it be used to deliver CPAP.

Question 8

What is the current recommendation for cord clamping following delivery?

Answer 8

If the infant is stable, cord clamping should be delayed 30-60 seconds. If unstable, clamp the cord and proceed with resuscitation.

Question 9

What is the best value at which to keep the PaO2 in the term newborn?

Answer 9

50-70 mmHg

Question 10

What are the target preductal SpO2 values during the first 10 minutes following an uncomplicated birth at term?

Answer 10

*** Table 1-7

Question 11

What initial inflation pressure and respiratory rates should be utilized if a neonate requires bag-mask ventilation in the delivery room?

Answer 11

Initial inflation pressures should be 20-25 cm H2O with a rate of 40-60 breaths per minute.

Question 12

What is the most important indicator of successful positive-pressure ventilation during newborn resuscitation?

Answer 12

Increasing heart rate is the most important indicator of successful positive-pressure ventilation during resuscitation.

Question 13

What are the weight cut-offs for determining which ET tube diameter to use in a neonate?

Answer 13

<1kg: 2.5 mm; 1-2kg: 3 mm; >2kg: 3.5mm

Question 14

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?

Answer 14

1kg: 7 cm; 2kg: 8 cm; 3kg: 9 cm; 4kg: 10 cm. An easy formula for remembering this is: 6 + weight in kg.

Question 15

What ET tube size should be used in a 1 kg infant?

Answer 15

2.5 mm x 7 cm

Question 16

What ET tube size should be used in a 2 kg infant?

Answer 16

3 mm x 8 cm

Question 17

What ET tube size should be used in a 3 kg infant?

Answer 17

3.5 mm x 9 cm

Question 18

What ET tube size should be used in a 4 kg infant?

Answer 18

3.5 mm x 10 cm

Question 19

At what point should cardiac compressions be initiated in a neonate?

Answer 19

If the HR is <60, after adequate ventilation, initiate external cardiac compressions.

Question 20

At what rate and ratio should compressions and ventilations be maintained during resuscitation of a neonate?

Answer 20

3:1 compressions to ventilations, with 90 compressions and 30 breaths to achieve approximately 120 events/minute.

Question 21

What does epinephrine do to the heart in a code situation?

Answer 21

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.

Question 22

What is the dose of epinephrine for neonates?

Answer 22

0.01 - 0.03 mg/kg (0.1-0.3 ml/kg) of 1:10,000 solution via IV (preferred) or endotracheal

Question 23

What is the most likely cause of bradycardia in the neonate during a code situation?

Answer 23

Ineffective bag-mask ventilation, esophageal intubation, or airway obstruction.

Question 24

Which neonatal resuscitation drug can be given via the endotracheal tube?

Answer 24

Epinephrine

Question 25

What is the best site for emergency intravascular access at birth?

Answer 25

Umbilical vein.

Question 26

Which drug, at what dose, can you give if you suspect the child is sedated due to maternal anesthetics or narcotics?

Answer 26

Naloxone at a dose of 0.1 mg/kg IM or IV, repeated as necessary.

Question 27

In what situation would one avoid the use of Naloxone in an infant exposed to maternal opiates?

Answer 27

If the mother had chronic opiate use, one should avoid giving the neonate naloxone because of the risk for precipitating acute withdrawal or seizures.

Question 28

How does the neonate’s surface area-to-body weight ratio compare to that of an adult?

Answer 28

The ratio is 3x higher in the neonate.

Question 29

What is the optimal delivery room temperature?

Answer 29

Between 73° and 76° F (23-24° C)

Question 30

At what gestational age would you consider using plastic to prevent heat loss in the preterm infant?

Answer 30

Infants <29 weeks of gestation should be placed in a clean, clear plastic bag up to the neck after delivery to minimize heat loss.

Question 31

What Apgar score, at what time, is indicative of high rates of mortality and permanent neurologic sequelae?

Answer 31

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.