Mod VII: Newborn Resuscitation in the Delivery Room

Question 1

_{Newborn Resuscitation in the Delivery Room}

Of the 3.5 million infants born each year what % requires resuscitation?

Answer 1

6%

Question 2

_{Newborn Resuscitation in the Delivery Room}

Incidence of infants born each year that requires resuscitation increases (80%) if weighing:

Answer 2

< 1,500 g

Question 3

_{Newborn Resuscitation in the Delivery Room}

Which Factors contribute to newborn depression?

Answer 3

Drugs used during labor and delivery

Trauma from labor and/or C-section

Fetal asphyxia (hypoxia and acidosis)

Question 4

_{Newborn Resuscitation in the Delivery Room}

Initial Treatment and Evaluation of Newborn Resuscitation in the Delivery Room involves:

Answer 4

Head down

^{Physician holds infant <strong>head down</strong> while cord clamped/cut}

Radiant warmer

^{Place supine under <strong>radiant warmer</strong> with head kept low and slight lateral tilt}

Dry immediately

FHR

^{Determine <strong>FHR</strong> via <u>Auscultation</u> or Detection of umbilical cord <u>pulsations</u>}

Aspirate

^{Aspirate mouth/pharynx/nose with catheter <u>not exceed 30 sec’s</u>}

Stimulate

^{Stimulate infant to deep breath/cry =><u> Slap soles of feet</u> or <u>rub back</u>}

^{Most infants are vigorous/crying within sec’s of delivery}

Free-flowing O2

^{Administer free-flowing O2 - Improves oxygenation and ↓ PVR}

Question 5

_{Newborn Resuscitation in the Delivery Room}

During initial resuscitation of a depressed Newborn how would MD hold infant while the cord is clamped/cut?

Answer 5

Head down

Physician holds infant head down while cord clamped/cut

Question 6

_{Newborn Resuscitation in the Delivery Room}

As the newborn’s head is delivered, how are nose, mouth, and pharynx treated?

Answer 6

They are suctioned with a bulb syringe

Question 7

_{Newborn Resuscitation in the Delivery Room}

After the remainder of the newborn’s body is delivered, how is the skin treated?

Answer 7

The skin is dried with a sterile towel

Question 8

_{Newborn Resuscitation in the Delivery Room}

During newborn delivery, when is the cord clamped?

Answer 8

Once the umbilical cord stops pulsating or

neonatal breathing is initiated

Question 9

_{Newborn Resuscitation in the Delivery Room}

Where is the newborn placed after the cord is clamped?

Answer 9

in a radiant warmer

with the bed tilted in a slight Trendelenburg position

Question 10

_{Newborn Resuscitation in the Delivery Room}

The classical method of clinically evaluating infants at 1 & 5 min after delivery is known as:

Answer 10

Apgar Scoring System

Question 11

_{Newborn Resuscitation in the Delivery Room}

What’s the Apgar Score of a newborn that has a pulse of 95bpm, good breathing, is active and crying vigorously, and has bleue extremities?

Answer 11

Apgar Score: 8pts

_{Activity - (muscle tone) (2pts)}

_{Pulse (1pt)}

_{Grimace - (reflex irritability)(2pts)}

_{Appearance - (skin color) (1pt)}

_{Respiration (2pts)}

Question 12

_{Newborn Resuscitation in the Delivery Room}

What’s the maximun number of points on the Apgar Scoring System?

Answer 12

10 pts

Question 13

_{Newborn Resuscitation in the Delivery Room}

Which newborn physiologic variables are measured by the Apgar Scoring System?

Answer 13

Pulse (0-2pts)

Respiration (0-2pts)

Appearance (0-2pts)

^{(skin color)}

Grimace (0-2pts)

^{(reflex irritability)}

Activity (0-2pts)

^{(muscle tone)}

Question 14

_{Newborn Resuscitation in the Delivery Room}

Which clinical condition describes a newborn with an Apgar Score of 0-3?

Answer 14

Severely depressed

Question 15

_{Newborn Resuscitation in the Delivery Room}

In what condition is a newborn with an Apgar Score of 4-6 considered to be in?

Answer 15

Moderately depressed

Question 16

_{Newborn Resuscitation in the Delivery Room}

In what condition is a newborn with an Apgar Score of 7-10 considered to be in?

Answer 16

Excellent condition

Question 17

_{Newborn Resuscitation in the Delivery Room}

What must the fisrt intervention for a moderately Depressed Infant (Apgar score 4-6) be?

Answer 17

Initial resuscitative methods

Question 18

_{Newborn Resuscitation in the Delivery Room}

What must resusciation interventions for a moderately Depressed neonate (Apgar score 4-6) be if the neonate remains apneic ?

Answer 18

PPV

PPV by bag/mask at rate of 40 breaths/min

Initial breath → may require pressure of 30 to 40 cm H2O

^{(to open up the airways)}

Subsequent breath → ↓ to 15 to 20 cm H2O

Initiate chest compressions

HR < 60 or maintained between 60 – 80 after 15 to 30 sec of ventilation => Initiate chest compressions

Question 19

_{Newborn Resuscitation in the Delivery Room}

Which HR values warrant initiation of chest compressions during the resusciation attempts for a moderately Depressed neonate (Apgar score 4-6) if the neonate remains apneic?

Answer 19

HR < 60 or

HR 60 – 80 after 15 to 30 secs of ventilation

=> Initiate chest compressions

Question 20

_{Newborn Resuscitation in the Delivery Room}

What are resuscitative interventions for the Severely Depressed Infant/neonate?

Answer 20

Establish ventilation w/o delay

Inspect glottis immediately

If meconium aspirated → suction at once through ET before lungs inflated

Severely depressed infants may require 3-8mins of artificial ventilation before spontaneous gasp taken

Question 21

_{Newborn Resuscitation in the Delivery Room}

During resuscitative attempts for the Severely Depressed Infant/neonate, what must be done if meconium aspirates are noted while inspecting the glottis?

Answer 21

Suction at once through ET before lungs inflated

Suction before ventilating to avoid spreading the meconium more distally

Question 22

_{Newborn Resuscitation in the Delivery Room}

How much time of resuscitative artificial ventilation may be required before Severely depressed infants/neonoates take a gasp?

Answer 22

3-8mins of artificial ventilation

Keep on ventilating for 3-8mins! Do No Stop!!!

Question 23

_{Newborn Resuscitation in the Delivery Room}

When are chest compressions required during resuscitation attemp on infants/neonates?

Answer 23

If HR < 60 despite adequate ventilation for 30 sec’s

Question 24

_{Newborn Resuscitation in the Delivery Room}

How are chest compressions performed during resuscitation of infant/neonates?

Answer 24

Compress Lower third of sternum

The Ratio of compression to ventilation is 3:1 or

100 compressions to 30 breaths/min

Maintain chest compressions until fetal spontaneous HR > 100 bpm

Question 25

_{Newborn Resuscitation in the Delivery Room} What's the Ratio of compression to ventilation during infant/neonate resucitation?

Answer 25

The Ratio of compression to ventilation is 3:1 or 100 compressions to 30 breaths/min

Question 26

_{Newborn Resuscitation in the Delivery Room} Chest compressions during infant/neonate resuscitation must be maintained until which fetal spontaneous HR values?

Answer 26

\> 100 bpm

Question 27

_{Newborn Resuscitation in the Delivery Room} Which drug should be considered during resuscitation of infant/neonates if depression results from maternal opioid?

Answer 27

**Naloxone**

Question 28

_{Newborn Resuscitation in the Delivery Room} Why should Naloxone be avoided during resuscitation of infant/neonates born to opiod-addicted mothers even when the depression results from maternal opioid?

Answer 28

To avoid precipitating **withdrawal**

Question 29

_{Newborn Resuscitation in the Delivery Room} During resuscitation of infant/neonates, which drug is used for the treatment of asystole or bradycardia resistant to effective ventilation and external cardiac massage for 30 sec's

Answer 29

**Epinephrine**

Question 30

_{Newborn Resuscitation in the Delivery Room} Why would infant/neonate require Acute blood volume expansion?

Answer 30

**Hypovolemia** frequently follows severe birth asphyxia Present as Pale, low arterial BP, tachypneic, tachycardic

Question 31

_{Newborn Resuscitation in the Delivery Room} Which solutions would be administered to treat Hypovolemia that frequently follows severe birth asphyxia?

Answer 31

**O-neg. blood** ^{Cross-matched with mothers blood} **NaCl** or **LR**

Question 32

_{Newborn Resuscitation in the Delivery Room} Why is Albumin no longer indicated in the treatment of the Hypovolemia that frequently follows severe birth asphyxia?

Answer 32

Associated with _increased mortality_