Week 11 Flashcards
what are the S&S of a healthy newborn?
- Cry vigorously
- Have a heart rate over 100 bpm within a minute after birth
- Be fully flexed: both arms and legs
- Become centrally pink by 7-10 minutes of age
When do you use suction on a newborn?
- Vigorous newborns do not require suctioning
- Only suction if obvious blood or meconium
- obstructing the airway: mouth then nose
- Use 10Fg or 12Fg catheter
What are some considerations for suctioning a newborn?
- Suctioning can cause complications:
- Delayed onset of effective breathing
- Laryngospasm & bradycardia
- Trauma to soft tissues
What is often able to stimulate breathing in a newborn?
Drying them
According to AV CPG’s ‘The Newborn Baby’, what steps do you take if the newborn is breathing adequately and has good muscle tone after delivery?
- continue to dry (especially the head)
- maintain warmth (skin to skin, blanket, hats)
- Routine suction is not recommended
- Monitor HR (ausciltation), breathing, tone and colour
- If Vital signs deteriorate or airway obstructed manage as per Newborn Resus.
According to AV CPG’s ‘The Newborn Baby’, what steps do you take if the newborn is breathing adequately and has good muscle tone after delivery AND DOES NOT REQUIRE RESUS?
Cut cord once it’s stopped pulsing (approx 1-2mins) unless parental preference is to have it remain attached.
- note APGAR score
According to AV CPG’s ‘The Newborn Baby’, what are the transport recommendations if the baby is Over 36 weeks gestation, uncomplicated and stable?
Tx to appropriate maternity service (pre-booked hospital)
According to AV CPG’s ‘The Newborn Baby’, what are the transport recommendations if the baby is 32-36 weeks AND stable VSS?
Tx to a level 2 hospital (paediatrician and midwife on site 24/7) in consultation with PIPER
According to AV CPG’s ‘The Newborn Baby’, what are the transport recommendations if the baby is under 32 weeks OR unstable VSS?
Tx to tertiary centre in consultation with PIPER
According to AV CPG’s ‘The Newborn Baby’, what are the transport recommendations if you are Rural?
Tx to nearest base hospital or hospital with maternity service and contact PIPER
What are the steps to Newborn resus in the AV CPGs?
After birth, being dried and skin to skin with mother:
- > assess breathing & muscle tone
2.
IF Apnoeic or gasping OR no muscle tone:
- stimulate by drying (not more than 30 seconds)
- Maintain warmth
- Placesupine with head/neck in neutral position
- suction only if airway obstruction is suspected
3.
-> re-assess breathing & muscle tone
4. IF HR<100 and/or apnoeic or gasping: - IPPV @ 40-60 per minute on room air - Pulse oximetry (right hand or right wrist) - ECG monitoring - reassess after 30 seconds
5.
-> re-assess breathing & muscle tone
- IF HR <60:
- CPR 3:1 ratio with oxygen (5L/min)
- Consult PIPER for all infants with HR<60
IF HR 60-100:
- IPPV @40-60bpm
- ensure adequate mask seal, airway position and increase ventilation pressure targeting chest riuse
- If no increase in HR then IPPV with o2 5L/min
IF HR>100 but o2<90:
Breathing laboured
- IPPV @40-60
Titrate o2 (1-5L/min) to meet target spo2
Breathing normally
- Maintain warmth and treat as newborn baby
- titrate o2 (1-2L/min) via nasal cannula to meet target sats
- discontinue o2 when spo2 >90%
What do you do in neborn resus if the HR<60 after stimulation and IPPV 40-60 for 30 seconds?
IF HR <60:
- CPR 3:1 ratio with oxygen (5L/min)
- Consult PIPER for all infants with HR<60
What do you do in neborn resus if the HR = 60-100 after stimulation and IPPV 40-60 for 30 seconds?
IF HR 60-100:
- IPPV @40-60bpm
- ensure adequate mask seal, airway position and increase ventilation pressure targeting chest riuse
- If no increase in HR then IPPV with o2 5L/min
What do you do in neborn resus if the IF HR>100 but o2<90 after stimulation and IPPV 40-60 for 30 seconds?
IF HR>100 but o2<90:
Breathing laboured
- IPPV @40-60
Titrate o2 (1-5L/min) to meet target spo2
Breathing normally
- Maintain warmth and treat as newborn baby
- titrate o2 (1-2L/min) via nasal cannula to meet target sats
- discontinue o2 when spo2 >90%
What are the steps for airway management in newborn resus
- Head in neutral or slightly extended position
- Padding may be required under shoulders
- Normally newborns do not require suctioning at birth. Suctioning can delay normal rise in oxygenation
- Suctioning should not be used except when babies show obvious signs of obstruction to either spontaneous respirations or IPPV
How d you suction a newborn?
Suction mouth first –then nose where needed. Use a soft 10 -12g catheter with <100mmHg pressure (AV guidelines)
How should a face mask be applied to a newborn?
Face mask should be applied using rolling motion from chin to nose bridge and held in place to ensure there are minimal leaks
What is the most important part of using a mask for a newborn?
Correct and adequate seal is imperative, it is therefore important to have a range of sizes available
what size LMA do you use for a neonate?
• Size 1 LMA / SGA for up to 5kg neonate
How can you confirm effective ventilations in IPPV?
Effectiveness of ventilations can be confirmed by observing:
- Increase in heart rate above 100/min
- A slight rise of the chest and upper abdomen with each inflation
- Oxygenation improves
When are chest compressions indicated for newborn resus?
Chest compressions are indicated when the heart rate is <60 despite adequate assisted ventilation provided for 30 seconds.
Why do you monitor spo2 on neonate right hand or arm?
to ensure SpO2 reading is pre-ductal (hand or wrist)
•Left hand and other body part may be influenced by the ductus arteriosus
What are the target saturation levels in neonatal resus after 1 minute?
60-70
What are the target saturation levels in neonatal resus after 2 minutes?
65-85
What are the target saturation levels in neonatal resus after 3 minutes?
70-90
What are the target saturation levels in neonatal resus after 4 minutes?
75-90
What are the target saturation levels in neonatal resus after 5 minutes?
80-90
What are the target saturation levels in neonatal resus after 10 minutes?
85-90
What do you do if baby is preterm (<32 weeks) or under 1500 grams?
- Increase environmental temperature
- Place in polyethylene plastic zip lock bag
- Put baby’s entire body in the bag (head out)
- Dry and cover the head (except the face) with a woollenhat or folded towel/blanket.
- Zip-lock the bag at the bottom (feet end) so the body is contained in the bag.
- Provide warmth around the bag (skin-to-skin with mother or warm towels).
What is the preverref IV access site in neonates?
umbillical vein
What are the benefits to intraosseous access?
• Provides a non-collapsible point of drug
entry.
- Peak plasma levels in 80-110 seconds versus 60-80 in central venous access
- Various locations, includes: proximal and distal tibia, humoral head and lower femur in paeds
What are the tertiary hospitals for maternity and neonate in Vic?
Tertiary centre (Metro births) –Consult PIPER
• Mercy, Monash, Women’s and RCH
- All infants <32 weeks’ gestation
- All intubated infants
- Level 2 public maternity hospital (Neonates >32 weeks and <37 weeks)
What is sudden unexpected death in infancy (SUDI)?
SUDIincludes:
• SIDS
• Other sudden death cause unknown (autopsy performed)
• Other ill defined and unspecified causes of mortality (no autopsy performed)
• Suffocation whilst sleeping (including asphyxiation by bedclothes and overlaying)
• Intentional child death
• Causes are undetermined
Define SIDS?
The sudden and unexpected death of an infant under 1 year of age, with onset of the lethal episode apparently occurring during sleep, that remains unexplained after a thorough investigation including performance of a complete autopsy, and review of the circumstances of death and the clinical history
WHat are some inherent SIDS risk factors
- Under 12 months
- 3-6 months
- Male
- Prematurity
- Multiple birth
- LBW
- Cold/infection
WHat are some PREVENTABLE SIDS risk factors
- Tummy/side sleeping
- Head covered
- Over heating
- Smoking
- CO2re-breathing
- Formula feeding
What is the ambulance response for SIDS?
The SIDS protocol ensures that;
• Parents are allowed to carry baby to ambulance and travel with them to hospital once police have finished their investigations
Infant and parents are transported to Emergency Department of :
• Royal Children’s Hospital,
• Monash Medical Centre,
• Frankston Hospital or,
• in country areas, nearest base hospital
What are some key points for paramedics responding to SIDS?
- Take time
- Slow down the process of events
- Involve Family members at all stages during the emergency period.
- Be aware of cultural differences
- Encourage them to see, touch and hold their child.
- Include the other children
- Offer Information
- Keep the family informed about what’s happening, and what happens next.
What is the police role n SUDI cases?
- Police are required to attend all SUDI, and have a legal mandate to act as a representative of the coroner
- Requirement to attend all sudden deaths
- Depending on circumstances, may notify other sections of the Victorian Police. Eg. Accident Investigation Section, Homicide, Arson Squad
- Support family
- Offer to telephone another family member, friend or doctor
- Offer information about what happens next
- Complete the appropriate forms (service dependent)
- Notify Coroner
