Neonatal Emergencies

Question 1

Define:

newborn

Answer 1

An infant for the first few hours after birth.

Question 2

Define:

neonate

Answer 2

An infant within the first 30 days of birth.

Question 3

What are the first steps to neonatal care?

Answer 3

1. warm
2. dry
3. stimulate
4. suction

Question 4

Which do you suction first in a neonate, the mouth or the nose?

Answer 4

Mouth first, it decreases the risk of aspiration.

Suctioning the nose first may cause the neonate to gasp and potentially inhale secretions from the mouth.

Question 5

How does a fetus receive oxygen in utero?

Answer 5

Through the placenta.

Question 6

What is considered preterm?

Answer 6

< 37 weeks

Question 7

What is considered a “term” baby?

Answer 7

38 - 42 weeks

Question 8

Fill in the blank.

If a newborn has adequate airway, breathing and circulation, he/she can be placed on the ____ _____.

Answer 8

mom’s chest

Question 9

What should you do as soon as the newborn’s head is delivered?

Answer 9

suction mouth, then nose

Question 10

Where should you keep the newborn to clamp the cord after the delivery?

Answer 10

Head slightly below the body and at level with mom.

Question 11

How do you ensure thermoregulation after delivery?

Answer 11

• Prewarmed towels
• Radiant warmer
• Drying body and head
• Cover with dry towel
• Cover the head with a cap

Question 12

What does APGAR stand for?

Answer 12

• Appearance - skin color
• Pulse rate
• Grimace - irritability
• Activity - muscle tone
• Respiratory- effort (cry)

Question 13

When should an APGAR score be recorded?

Answer 13

1 minute & 5 minutes after birth.

(If < 7 Q 5minutes)

Question 14

Review the Neonatal Resuscitation Algorithm.

Answer 14

Question 15

What is target HR for neonate?

Answer 15

>100bpm

Question 16

What size BVM mask should be used during PPV for a neonate?

Answer 16

newborn mask

Question 17

What are common PIP and PEEP pressures used during PPV?

Answer 17

PIP 25

PEEP 5

Question 18

You have been resuscitating your newborn properly for 60 seconds.

The HR shows 80 bpm, what should you do?

Answer 18

Ensure correct ventilation.

Question 19

How can you stimulate the newborn?

Answer 19

• Suctioning the nose (after mouth).
• Flick the soles of feet.
• Rub the back.

Question 20

What is the Vt (tidal volume) of a newborn?

Answer 20

3-6 ml/kg

Question 21

What rate of ventilations do you provide to a newborn?

Answer 21

40-60/min

Question 22

It has been 90 seconds with proper resuscitation, however the newborn’s HR has dropped to 58 bpm, what should you do?

Answer 22

Begin chest compressions.

Question 23

How many veins and arteries does the umbilicus have?

Answer 23

2 arteries, 1 vein

Question 24

What is the dose of epinephrine for bradycardia in a newborn?

Answer 24

1:10,000: .01 - .03 mg/kg (.1 - .3ml/kg)

Always follow the administration by a .5 - 1ml normal saline flush.

Question 25

What is the **dose** for a **fluid bolus** in a newborn?

Answer 25

10 ml/kg ## Footnote *Normal Saline, LR, Blood*

Question 26

What is the **dose** of **narcan** for suspected drug-addicted mother and floppy newborn?

Answer 26

.1 mg/kg IV/IM

Question 27

What **BGL** is considered **hypoglycemic** in a newborn?

Answer 27

\< 40 mg/dL

Question 28

# Treatment: newborn hypoglycemia

Answer 28

D10 2 ml/kg

Question 29

What is the _location_ for **needle decompression** in a newborn?

Answer 29

2nd intercostal midclavicular ## Footnote 22G butterfly needle

Question 30

# Define: diaphragmatic hernia

Answer 30

A **rupture of abdominal contents** through the diaphragm into the chest. ## Footnote Increases intrathoracic pressure and decreases lung functional capacity.

Question 31

Why are premature newborns at a **higher risk** of respiratory difficulties?

Answer 31

Due to surfactant deficiency.

Question 32

# Treatment: seizures in newborn

Answer 32

* proper assessment * check BGL * Consult med control for medications.

Question 33

# Define: pulmonary stenosis

Answer 33

Damaged pulmonic valve. ## Footnote It causes JVD, cyanosis, RVH.

Question 34

If the **foramen ovale** is unable to close after birth, what happens?

Answer 34

**Deoxygenated** blood is able to shift to the right or left and mix with **oxygenated** blood.

Question 35

What is a **ventricular septal defect**?

Answer 35

The **LV forces blood back into the RV**. ## Footnote It causes pulmonary hypertension.

Question 36

# Define: Patent Ductus Arteriosus

Answer 36

Connects the **pulmonary artery to the aorta**. ## Footnote If it fails to close, blood bypasses the RV and lungs due to lungs being filled with fluid.

Question 37

# Define: Hypoplastic Left Heart Syndrome

Answer 37

Underdevelopment of the **left** side of the heart. ## Footnote It causes the left side of the heart to be unable to keep up with circulation needs of the newborn.

Question 38

# Define: Tricuspid Artresia

Answer 38

**Absense** of the **tricuspid valve**. ## Footnote It causes an undersized or absent RV.

Question 39

# Define: Tetralogy of Fallot

Answer 39

**_4 Heart Defects_** 1. Ventricular Septal Defect 2. Pulmonary Stenosis 3. Right Ventricular Hypertrophy 4. Overriding Aorta

Question 40

# Define: transposition of the great arteries

Answer 40

The aorta and the pulmonary artery are **switched**.