Lesson 5

Question 1

After the baby has been successfully resuscitated, can baby be given back to mom immediately?

Answer 1

No, they may need ongoing support from NICU if they received PPV, or supplemental oxygen

Question 2

Define hypoxic ischemic encephalopathy ( HIE )

Answer 2

A type of brain injury that happens after lack of oxygen to brain

Question 3

When should babies not be allowed to become hypothermic or hypothermic ?

Answer 3

When they have HIE

Question 4

What should be monitored after baby receives resuscitation? (8)

Answer 4

Blood oxygenation
Heart rate
Breathing rate
ECG
Blood pressure
Urine output
Fluid intake
Body temp

Question 5

What initial studies could be necessary after baby receives resuscitation? (6) CCCBEL

Answer 5

Electrolytes including calcium
Blood glucose ASAP
Liver function (if indicated)
Complete blood count (if indicated)
Coagulation panel (if indicated)
Chest/abdomen xray (if indicated)

Question 6

What’s ROSC

Answer 6

Return of spontaneous circulation

Question 7

After ROSC what signs should be reviewed on baby for the neurological system?

Answer 7

Apnea
Seizures
Poor tone
Abnormal neurological exam

Question 8

After ROSC what signs should be reviewed on baby for the pulmonary system?

Answer 8

Tachypnea (rapid breathing)
Grunting
Retractions
Nasal flaring
Low SpO2

Question 9

After ROSC what signs should be reviewed on baby for the cardiovascular system?

Answer 9

Hypotension (low blood pressure)
Tachycardia (high heart rate 100+)

Question 10

After ROSC what signs should be reviewed on baby for the renal (filters waste, kidneys) system?

Answer 10

Decreased urine output
Ademia

Question 11

After ROSC what signs should be reviewed on baby for the gastrointestinal system?

Answer 11

Intolerant to feeding
Vomiting
Abdominal distention

Question 12

After ROSC what signs should be reviewed on baby for the metabolic (chemical reaction in cells) system?

Answer 12

Metabolic acidosis (excess acid in body fluids)
Hypoglycemia (low blood sugar)
Electrolyte disturbances

Question 13

After ROSC what signs should be reviewed on baby for the hemotologic (study of blood) system?

Answer 13

Pallor (deficiency of color of face)
Bruising
Petechiae (rash, round - reddish purple less than 2mm)

Question 14

If hypotension is present what should be monitored?

Answer 14

Frequent blood pressure and heart rate monitoring

Question 15

What could hypotension be associated with?

Answer 15

Tachycardia

Question 16

If hypotension is present neonates may need ____ or in severe cases and introscope such as ____, or _____

Answer 16

Normal saline, dopamine, dobutamine

Question 17

Pulling hypotension is more common in neonates who are ___ weeks gestation

Answer 17

34

Question 18

What is pulmonary hypertension (blood pressure in lungs is high) treated with?

Answer 18

Supplemental oxygen
Ventilatory support
Inhaled nitric oxide
Extracorporeal membrane oxygenation (severe cases) (blood is pumped outside of the body to a heart-lung machine. The machine removes carbon dioxide and sends oxygen-rich blood back to the body.)

Question 19

What can be used to diagnosis pneumonia and pneumothorax?

Answer 19

Chest xray

Question 20

What are 3 electrolyte abnormalities

Answer 20

Hyponatremia (low sodium, body holds too much water)
Hyperkalemia (high potassium)
Hypocalcemia (low calcium)

Question 21

Electrolyte abnormalities can usually be treated with supplementation except hyperkalemia may need specialist care and could need treated with _____ or _____,______

Answer 21

IV calcium, IV insulin and glucose

Question 22

What can lead to metabolic acidosis (excess lactic acid)?

Answer 22

Extended periods of hypoxemia (low oxygen in blood)

Question 23

What can treat acidemia (blood disorder low pH)?

Answer 23

Increased ventilation if it doesn’t normalize spontaneously

Question 24

What is not used to treat metabolic acidosis?

Answer 24

Sodium bicarbonate

Question 25

Is lactic acidosis the only cause of metabolic acidosis.

Answer 25

No, it's important to find other causes

Question 26

Is hypoglycemia relatively normal/abnormal in healthy neonates?

Answer 26

Normal

Question 27

What can further diminish liver glycogen stores in hyperglycemic neonates?

Answer 27

Resuscitation

Question 28

The definition of hypoglycemic neonates is hotly debated. So what judgement is needed

Answer 28

Clinical

Question 29

What do you give neonates post resuscitation to treat hypoglycemia?

Answer 29

Dextrose or glucose gel

Question 30

What type of glucose monitoring in neonates is notoriously inaccurate?

Answer 30

Heel prick (falsely low)

Question 31

Hypoglycemia treatments should be guided by what?

Answer 31

Lab glucose plasma when possible

Question 32

List common conditions after resuscitation (9) HPEMHGAHH

Answer 32

Hypotension Pulmonary complications Electrolyte abnormalities Metabolic acidosis Hypoglycemia Gastrointestinal problems Acute tubular necrosis Hematologic abnormalities Hypoxic ischemic encephalopathy

Question 33

What gastrointestinal problems should providers look for in a neonate after resuscitation? What are clues to the signs?

Answer 33

Gastrointestinal bleeding Ileus Feeding intolerance (Parenteral nutrition may be needed) Clues: intolerance to feeding, vomiting, abdominal distention

Question 34

What's parenteral nutrition?

Answer 34

a medical treatment that delivers nutrients directly into a vein to provide calories, protein, vitamins, minerals, and fats

Question 35

What's the most common kidney complication of neonatal resuscitation?

Answer 35

Acute tubular necrosis

Question 36

What does acute tubular necrosis cause? ___, &____

Answer 36

Urinary retention & electrolyte disturbances

Question 37

What in acute tubular necrosis is associated with high urine output?

Answer 37

Late phases

Question 38

In acute tubular necrosis what 2 things should be monitored closely?

Answer 38

Fluid and electrolytes and treat accordingly

Question 39

With hematologic abnormalities what test run, can reveal anemia, thrombocytopenia, or elevated white blood count (suggests an infection)?

Answer 39

A simple complete blood cell count (CBC)

Question 40

Neonates with _____ & _____ & _____ may develop Hypoxic ischemic encephalopathy.

Answer 40

Prolonged hypotension Hypoxemia Acidemia

Question 41

Symptoms of Hypoxic ischemic encephalopathy may include: (But these symptoms could also be caused from opioid withdrawal or infection)

Answer 41

Apnea Seizures (occuring later) Poor tone Abnormal neurologic exam

Question 42

What can help babies with Hypoxic ischemic encephalopathy (neurological issue) ? And when should treatment be implemented?

Answer 42

Therapeutic hypothermia, treatment ASAP even if it requires a transfer.