1: Neonatal - birth asphyxia

Question 1

Define birth asphyxia

Answer 1

Perinatal compromise of gas exchange

Question 2

What may birth-asphyxia cause

Answer 2

Hypoxic-Ischemic Injury

Question 3

Give 5 causes of birth-asphyxia

Answer 3

• Placental abruption
• Cord collapse - compressing umbilical flor
• Retained lung fluid
• Pre-mature
• Maternal analgesia

Question 4

When is APGAR score used to assess a child

Answer 4

1-minute

5- minutes

Question 5

What is the one-minute APGAR score used for

Answer 5

Determine if the neonate requires resuscitation

Question 6

What 5-minute APGAR score requires further intervention

Answer 6

<7

Question 7

What does APGAR stand for

Answer 7

Appearance

Pulse

Grimace

Activity

Respiration

Question 8

How will the following appear for 0-points

A.  Appearance 
B.  Pulse 
C  Grimace 
D. Activity 
E. Respiration

Answer 8

A. Blue 
B. None 
C. None 
D. None 
E. None

Question 9

How will the following appear for 1-point

A. Appearance
B. Pulse
C. Grimace
D. Activity 
E. Respiration

Answer 9

A. Pink Trunk, Blue-Limbs 
B. <100 
C. Grimace 
D. Flexion 
E. Weak cry, Slow-irregular breathing, Gasping

Question 10

How will the following appear for 2-points

A. Appearance
B. Pulse
C. Grimace
D. Activity 
E. Respiration

Answer 10

A. Pink body, Pink extremities 
B. Pulse >100 
C. Cry, Active withdrawal 
D. Active motion 
E. Regular breathing, strong cry

Question 11

Define hypoxic-ischaemic encephalopathy

Answer 11

Manifestation of brain-injury within 48h of birth asphyxia

Question 12

How may birth asphyxia be detected antenatally

Answer 12

CTG:

• Late decelerations = Placental insufficiency
• Variable decelerations = Cord prolapse

Question 13

What % of severe HIE will have neurological sequelae

Answer 13

80

Question 14

If a baby has severe HIE what is ordered at 4-14days

Answer 14

MRI

Question 15

What findings on MRI may indicate cerebral palsy

Answer 15

• Bilateral anomalies in BG, thalamus and internal capsule

Question 16

What is the most common reason for neonatal life support

Answer 16

Respiratory conditions causing prolonged asphyxia leading to cardiac arrest

Question 17

What is first-line in paediatric BLS

Answer 17

Open airway:

• Head tilt
• Chin lift
• Jaw thrust

Question 18

What is second-line in paediatric BLS if neonate is not breathing

Answer 18

5 Rescue breathes

Question 19

If no signs of life what is performed following rescue breathes

Answer 19

15 Chest compressions

Question 20

What is the ratio of breathes to chest compressions

Answer 20

15:2

Question 21

When should resus team be called

Answer 21

If alone perform 1-minute chest compressions prior to contacting resus team

Question 22

In infants under 1-year what position should they be in to open airway

Answer 22

Neutral position with jaw thrust

Question 23

In children over 1-year, what position should they be in to maintain airway

Answer 23

‘Sniffing air position’

With haw thrust

Question 24

How long should you wait to determine patancy of the airway

Answer 24

10-Seconds

Question 25

How many rescue breathes are given in paediatric BLS

Answer 25

5 rescuer breathes

Question 26

What pulses should be checked for life in infants and children

Answer 26

Children: carotid Infants: brachial and femoral

Question 27

When should chest compressions be started

Answer 27

No pulse in 10-seconds

Question 28

What are indications for chest compressions

Answer 28

- No pulse - Or, HR <60 - No signs life

Question 29

What technique is used for chest compressions in infants

Answer 29

Encircling technique: place hands around lower-sternum and use thumbs for CPR

Question 30

Define hypoxic ischaemic encephalopathy

Answer 30

Clinical presentation brain injury due to hypoxic-ischaemic insult

Question 31

How can cause of HIE be divided

Answer 31

Antenatal Perinatal Postnatal

Question 32

What causes HIE

Answer 32

Umbilical cord prolapse | Placental abruption

Question 33

What are mild symptoms of HIE

Answer 33

- Hyperventilation - Hyper-responsive - Irritable - Impaired feeding

Question 34

What are moderate symptoms of HIE

Answer 34

- Reduced movement - Lethargy - Seizures

Question 35

What are severe symptoms of HIE

Answer 35

- Hypotonia - No movement - Prolonged seizures - Multi-organ failure

Question 36

Explain management of HIE

Answer 36

- Resuscitation - Therapeutic hypothermia - Cerebral function analysis monitoring (CFAM) - Withhold feeding 1-2d and re-introduce gradually

Question 37

What are the three indications for therapeutic hypothermia

Answer 37

1. Infant >1.8Kg and >36W with one of: - Cord gas or ABG with acidosis (pH <7) - APGAR < 5 at 10-minutes 2. Moderate to severe HIE: - Hypotonia - Seizures - Hyporeflexia If criteria 1 or 2 are met, test for criteria 3 3. 30-minutes seizure activity on cerebral function analysis monitoring

Question 38

What is standard of care of infants with moderate-severe HIE

Answer 38

Therepetic hypothermia

Question 39

What is therapeutic hypothermia

Answer 39

Uses temperature control mat to maintain infants body T between 33-34'

Question 40

How long is therapeutic hypothermia maintained for

Answer 40

72-hours

Question 41

What are 5 complications of HIE

Answer 41

1. Spastic quadriplegia 2. Dyskinetic cerebral palsy 3. Low IQ 4. Cortical blindness 5. Hearing loss 6. Epilepsy