WK4- Newborn Resuscitation Flashcards
What are the 2 key mechanisms that occur when a newborn takes their initial breath?
When a newborn takes their initial breaths this results in:
1- Absorption of the fluid that fills theirs lungs at birth
2- This absorption triggers an increase in pulmonary blood flow, oxygenating the patient
What are 5 risk factors this make newborns more likely to need resuscitation?
Babies who required resus were more likely to:
1- Have an APGAR score less than 7
2- Be of low birth weight
3- Be born pre-term
4- Be born as part of a multiple birth
‘Active Resuscitation’ for newborns incorporate 4 components. What are these?
Active Resuscitation:
1- Suctioning
2- Oxygenation
3- Ventilation
4- Compressions
“Many ambulance services recommend resuscitation is withheld in infants who are less than ___ weeks gestation”
Many ambulance services recommend resuscitation is withheld in infants who are less than 23 weeks gestation
What are the 4 key components of ‘The Golden Minute’ following birth?
The Golden Minute-
1- Drying
2- Warming
3- Airway Techniques
4- Stimulation
Newborn DRABCD Algorithm- When assessing a newborns RESPONSE directly after birth, what are indications the baby is Healthy?
Healthy Newborn RESPONSE:
1- Good muscle tone (not floppy)
2- Extremity flexion or active movement of limbs
Newborn DRABCD Algorithm- When assessing a newborns RESPONSE directly after birth, what are indications the baby is Compromised?
Compromised Newborn RESPONSE:
1- Poor muscle tone (floppy)
2- Minimal movement of limbs
Newborn DRABCD Algorithm- When assessing a newborns AIRWAY directly after birth, what are indications the baby is Healthy?
Healthy Newborn AIRWAY:
1- Clear, nil obstructions
2- No visible secretions in mouth/airway (eg. blood, meconium)
Newborn DRABCD Algorithm- When assessing a newborns AIRWAY directly after birth, what are indications the baby is Compromised?
Compromised Newborn AIRWAY:
1- Secretions (eg. blood, meconium) are obstructing the airway
Newborn DRABCD Algorithm- When assessing a newborns BREATHING directly after birth, what are indications the baby is Healthy?
Healthy Newborn BREATHING:
1- Fast, regular respirations
2- Spo2 is within target range for duration after birth
Newborn DRABCD Algorithm- When assessing a newborns BREATHING directly after birth, what are indications the baby is Compromised?
Compromised Newborn BREATHING:
1- Gasping or Apnoea
2- This Gasping/Apnoea is alongside HR <100 bpm
Newborn DRABCD Algorithm- When assessing a newborns CIRCULATION directly after birth, what are indications the baby is Healthy?
Healthy Newborn CIRCULATION:
1- HR >100bpm
Newborn DRABCD Algorithm- When assessing a newborns CIRCULATION directly after birth, what are indications the baby is Compromised?
Compromised Newborn CIRCULATION:
1- HR <100bpm
Newborn DRABCD Algorithm- When assessing a newborns RESPONSE directly after birth, you notice poor muscle tone (floppy) & minimal movement of the limbs. What INTERVENTION will you do?
Intervention-
1- Provide tactile stimulation by gently, but briskly, rubbing the newborn’s back, trunk or extremities with a towel
2- Rub abdomen up & down
3- Flick the underside of newborns feet
What must you NOT do when providing Tactile Stimulation to a newborn?
Do NOT- Slap, Squeeze or Shake the newborn
What is the RATIONALE for providing Tactile Stimulation to a newborn that has poor muscle tone (floppy) and minimal movement of their limbs?
Rationale for Tactile Stimulation-
a) Rouses the non-vigorous newborn
b) Stimulates breathing in an inadequately ventilating newborn
c) Warms newborn to aid maintenance of normothermia of newborn
Newborn DRABCD Algorithm- When assessing a newborns AIRWAY directly after birth, you notice secretions of blood and meconium obstructing the airway. What INTERVENTION will you do?
Interventions for obstructed airway-
1- Position baby supine with the head supported in a neutral position (avoiding flexion/extension of the neck). This position can be achieved by placing 2-5 cm of padding underneath the shoulders
2- Position newborn head on the side and gently wipe the mouth with edge of towel
3- IF suctioning is required (eg. obstruction is preventing newborn from breathing), the mouth should be suctioned first
What is the RATIONALE for the neutral alignment of a newborns head during airway management?
RATIONALE for Neutral Alignment-
a) Newborns have a large occipital region (they have a large head, short neck, large tongue)
b) Newborns tracheal diameter is narrower and trachea is shorter, so flexion or hyperextension of neck can occlude airway
What is the RATIONALE for clearing newborns airway by positioning their head on the side & using the edge of a towel as opposed to using suction?
RATIONALE for manual removal of obstructions-
a) Positional clearing of the airway is preferred over suctioning as suctioning does not remove liquid from lungs
b) Suctioning can cause vagal reactions leading to laryngeal spasm, bradycardia, & delay in onset time to spontaneous ventilation. It can also decrease oxygen saturation and increase infection risk
IF Suctioning is required to clear a newborns obstructed airway…What is the RATIONALE for suctioning the mouth first (before the nose)?
RATIONALE for suctioning mouth first-
a) The newborn is a nasal breather and may gasp and inhale pharyngeal fluid if the nose is cleared first
b) This ensures that any blood in the pharynx is cleared and cannot be inhaled once the baby’s nostrils are clear
Newborn DRABCD Algorithm- When assessing a newborns BREATHING directly after birth, you notice that they are Gasping or Apnoeic. What is the other VITAL SIGN you want to check at this stage to determine your next course of action?
Check Heart Rate!
Why? Because if the newborn is gasping/apnoeic AND their HR is <100bpm then you will need to start resus efforts (IPPV using BVM)
Newborn DRABCD Algorithm- When assessing a newborns BREATHING directly after birth, you notice they are gasping/apnoeic & their HR is <100bpm. What INTERVENTION will you do?
Interventions for Ineffective Breathing (Gasping/Apnoea) alongside HR <100bpm:
1- Ventilate newborn with BVM to supply IPPV (Intermittent Positive Pressure Ventilation)
1a- IPPV Rate= 40-60 breaths/min
1b- IPPV % Oxygen= Room Air
1c- IPPV Inspiratory Time= 0.5secs
1d- IPPV Duration= 30 secs before reassessment of HR
Newborn DRABCD Algorithm- When ventilating a newborn with IPPV (Intermittent Positive Pressure Ventilation) ensure that:
a) IPPV Rate [ __ breaths/min]
b) % Oxygen
c) IPPV Inspiratory Time [ __ secs]
d) Duration before HR reassessment
Ventilation of newborn with BVM to supply IPPV (Intermittent Positive Pressure Ventilation)-
a) IPPV Rate= 40-60 breaths/min
b) % Oxygen= Room Air (21%)
c) IPPV Inspiratory Time= 0.5secs
d) IPPV Duration= 30 secs before reassessment of HR
What is the VOLUME (mL) and TIDAL VOLUMES range (__mL- __mL) of a Newborn BVM?
Newborn BVM:
a) Volume= 240mL
b) Tidal Volumes= 10-35mL
