Week 4 - Newborn Life Support (NLS) Flashcards
Facts about baby’s regarding NLS?
- up to 85% of baby’s breath spontaneously after birth, without intervention.
- a further 10% respond after drying, stimulation and airway maneuvers.
- Approximately 5% receive positive pressure ventilation.
- Fewer than 0.3% of infants receive chest compression’s.
Those baby’s that do need help , usually respond best to effective lung aeration.
Potential complications that may require NLS?
- The problem is a respiratory one.
- A newborn’s heart is healthy and primed to
function. - Foetal lungs are filled with lung fluid and have
never inflated with air before. - The baby may be hypoxic.
Foetal response to labour?
- Labour is a relatively Hypoxic event for babies. They can cope with this because:
- higher and different Hb
- a newborns heart can continue beating for 20 minutes or longer, despite Anoxia.
- Newborns brain can withstand Anoxia longer than an adults.
What does Anoxia mean?
No Oxygen supply to tissues.
How does a baby transition to Extra-uterine life?
first breath stimulated by:
- mild hypoxia caused by labour
- increased arterial CO2 levels and decreased PH cause stimulation of central chemo receptors.
- meeting the air
How long after birth do babies usually take their first breath?
most babies will take their first breath within 10-30 seconds of birth, they will usually establish effective breathing within 90-120 seconds.
What does a WELL (healthy) baby look like?
- born blue but becomes centrally pink during the first 90 seconds or so after birth.
- has good muscle tone (not floppy)
- cries within a few seconds after birth.
- good heart rate of 100-160BM.
What does a less well (medium poorly) baby look life?
- blue at birth and doesn’t pink up so quickly.
- reduced tone ( a bit floppy)
- inadequate or absent respirations.
- slow heart rate (<100).
- observe closely, stimulate and be ready to act.
What does an unwell baby (very poorly) look like?
- born pale
- floppy
- not breathing
- heart rate <60/min or undetectable.
- commence resuscitative measures urgently.
What is a standard grade approach to childbirth?
1) dry and cover baby skin-to-skin with mum, cord intact, stimulating the baby if necessary.
2) Assess
3) Airway
4) Breathing
5) Circulation
Why is drying the baby and putting the baby skin-to-skin with mother important?
- heat loss can be very rapid in pre-hospital setting; 0.1-0.3 degrees Celsius lost every minute the baby is exposed.
- in low birth weight babies, mortality increases by 28% for every 1 degree below 36.5 degress Celsius.
Hypothermia can be caused as a result, which can lead to:
- hypoxia
- acidosis
- impaired surfactant synthesis
- coagulation defects.
How to ventilate a baby if necessary?
Choose a mask that fits.
Always start with 5 inflation breaths
to open the baby’s lungs, using a
bag and mask for 2-3 seconds on
each inflation. You should see chest
rise with 4th or 5th inflation breath.
Re-assess (heart rate is key).
If successful, heart rate will increase and baby will respond.
Continue with ‘ventilation breaths’
at 30-40/min until baby is breathing
on its own, reassessing every 30 sec.
What is a potential cause of airway obstruction in a newborn baby?
Thick meconium
How to manage circulation in a new born baby?
When the chest has risen and the lungs have been aerated, the heart rate should increase.
If the chest has risen but the heart rate is not increasing, perform 30 seconds of ventilation breaths at 30-40/min.
If heart rate still not rising, commence chest compressions at a ratio of 3:1 with ventilations,
reassessing every 30 sec.
DO NOT PERFORM CHEST COMPRESSIONS UNTIL YOU HAVE SEEN THE CHEST RISE !!!
Chest compressions:
Use two-thumbs or two-fingers method.
Compress the lower third of the sternum, just below the nipple line by about 1/3 depth of baby’s chest.
3 chest compressions to 1 ventilation (i.e. 90 compressions + 30 ventilations per minute = 30 cycles every min or 15 cycles every 30 seconds).
Reassess every 30 seconds (heart rate is key)
