WK7: Neonatal resuscitation, NST, Neonatal injections Flashcards
Outline the steps for a neonatal resus.
DRSABACD
Danger
- other equipment in the room
Response
- term?
- does it look term?
- muscle tone?
- breathing or crying?
NO- tactile stimulation, maintain temp, ensure open airway
YES- maintain temp + obs
Access + airways
- HR below 110bpm?
- Gasping or apnoea
Yes= initiate positive pressure ventilation, have O2 sats on baby, suction if necessary
Breathing
- 1min to assess if baby needs breathing
- normal infant breathing= 40-60 per minute
Abnormal breathing
- gasping
- apnoeic
- laboured breathing
- ? persistent cyanosis
Action:
- Put neopuff around baby nose and mouth
- Give 40-60 breaths per minute
- Put sats monitor on to get HR
- Looking for improvement in HR
- If not improvement, improve neopuff
- Rate: 40 – 60 breaths per minute
- Improvement in heart rate is the primary measure of adequate ventilation
Compressions
- 3:1 compressions to breaths
- start when HT <60 despite good ventilation
Drugs
- Blood
- adrenaline
- IV fluids/volume exmanders
What is the ideal position for a baby in resus?
- Assist baby to get into a supine open/sniffing position
- Lie baby as flat as possible
- If caput is forcing babys chin down you can use towel under shoulder to tilt head back.
What are some important points regarding suctioning?
- Only suction what you can see
- Suction the nose before mouth (nose breather)
Suctioning is recommended when:
- There is obvious blood
- Mucous
- meconium
Use a Fg 10 or Fg 12 suction catheter
The negative suction pressure used should not exceed 100 mmHg (13 kPa, 133 cmH2O, 1.9 Psi)
Be quick (no more than 5 – 6 seconds) and gentle, as over-vigorous suctioning can cause laryngeal spasm, bradycardia, trauma and delay the onset of spontaneous breathing.
Why is mec aspiration an risk? How do we manage it?
MSAF= me stained amniotic fluid
AS= mec aspiration syndrome
A risk of sepsis and resp depression as it is a thick substance that compromises the lung capabilities.
Management=
- Vigorous at birth? Breathing + tone?
- Tactile stimulate at birth
- If non-vgorous= endotrachiale suctioning intubation by peads
- Ventilate before suctioning (no evidence for endotrachael sucktioning)
When should PPV be commenced?
IF HR < 100/min or inadequate breathing= commence ventilation (PPV)
What is PPV, what device is used to provide it and what should it be set to?
Positive pressure ventilation gives a breath but on exhale, does not fully relax the lungs to ensure they are easily expanded on the next inspiration.
Provided via a T piece or neo puff
30/5
What should a neopuff be set to? and why?
Peak inspiratory pressure (PIP)= is set to 30cmH20
- Push of air into the lungs
- When pressing down on the neo puff
Positive expiratory end pressure (PEEP)= at 5-8cmH20 for term infants at birth (different for preterm or not immediate birth resus)
- Little bit of effort at the start of plowing a ballon
- Holds the lungs slightly open
What is the importance of the peep?
Without peep
- Lung aeration is not achieved as quickly
- Functional residual capacity (FRC) is not established
With PEEP
- FRC is established and maintained
- Oxygenation is improved
PEEP of 5 – 8 cm H2O during resuscitation of newborn infants if appropriate equipment available
What should the O2 and air bet set to?
21%= initially
100%= resus
- O2 introduced when no improvement in pulse oximetry despite ventilation efforts.
- Increase oxygen to 100% for chest compressions
What are some key signs of effective ventilation?
- Keys sign= increase HR of above 100beats/min
- Other signs= a rise and fall of the chest + oxygenation improves
- Reassess the HR every 30 secs whilst providing PPV
- Intubation may be indicated
If it hasn’t improved. ?am I ventilating effectively - Ventilate at a rate of 40 – 60 inflations per minute
Where should the pulse oximeter be placed?
on the right wrist or hand (preductal oxygen saturation)
- The right side is the most oxygenated blood and this refectlts brain stem oxygen delivery.
What are the target O2 sats after birth
Time from birth Target saturations
1 minute 60 – 70%
2 minutes 65 – 85%
3 minutes 70 – 90%
4 minutes 75 – 90%
5 minutes 80 – 90%
10 minutes 85 – 90%
What should the pip and peep flow rate be set at? (in L)
Pip= 30cmH20
Peep= 5cmH20
When are external chest compressions indicated?
HR is <60BPM despite adequate assisted ventilation.
What is the rate of chest compressions to breaths at what % of O2?
Commence chest compressions with PPV at a ratio of 3:1 with 100% oxygen
- Aim for 120 events/minute
Describe effective chest compressions
- Aim for 120 events/minute
- Use 2 thumb encircling method or 2 finger technique
- Chest compressions are performed over the lower third of the sternum
- The person providing the chest compressions should verbalise (out loud): “One – and – two – and – three – and – breathe, one – and – two – and – three – and – breathe.”
What is the first line drug used in a neonatal resus?
Adrenaline
- 1:10,000
- given via ETT or IV
- amount depends on size of baby and route
What is the second pharmacological drug used in neonatal resus?
- Normal saline or blood
- 10mL/kg (average baby is 3.5kg)
When should you stop a resus?
Discontinue if:
- Compressions if HR >60bpm and rising
- PPV when HR is >100bpm and baby is breathing normally
- Continue PPV until HR >100bpm
What is the newborn screening test?
A blood test that is free to all aus babys with the aim to to test babys for metabolic symtpoms prior to the onset of symtpoms to reduce morbidity and mortality.