Neonatal resuscitation Flashcards
(17 cards)
What is hypoxia?
It’s a key concern in neonatal resuscitation. Normal labour and birth leads to certain amounts of hypoxia. When contractions happen, the placenta is unable to carry out normal gas exchange, leading to hypoxia.
What does extended hypoxia lead to?
Extended hypoxia leads to anaerobic respiration, bradycardia, reduced consciousness, and a drop in respiratory effort, worsening hypoxia.
What can extended hypoxia to the brain lead to?
Extended hypoxia to the brain can lead to hypoxic-ischaemic encephalopathy, with potential lifelong consequences in the form of cerebral palsy.
What are some issues in neonatal resuscitations?
- babies have a large SA:weight and get cold very easily
- baby’s are born went, so they loose heat rapidly
- babies that are born through meconium may have this in their mouth or airway
How and why should you warm the baby?
- get the baby dry ASAP
- vigorous drying helps stimulate breathing
- warm delivery rooms and manage under a heat lamp
- babies under 28 weeks are placed in a plastic bag while still wet and managed under a heat lamp
What is the APGAR score?
- appearance (skin colour), pulse, grimace (reflex irritability), activity (tone), respiration
- done at 1,5 and 10 minutes whilst resuscitation continues (if severely unwell, do an assessment at 20 minutes too)
- used as an indicator of the progress over the first minutes after birth
- helps stimulate neonatal resuscitation efforts
- lowest score = 0, highest = 10
How can you stimulate breathing?
- stimulate the baby to prompt breathing eg. drying vigorously with a towel
- place the baby’s head in a neutral position to keep the airway open - a towel under the shoulders can help to keep it neutral
- if gasping or unable to breathe, check for airway obstruction eg. meconium and consider aspiration under direct visualisation
When are inflation breaths given?
Inflation breaths are given when the neonate is gasping or not breathing despite adequate initial stimulation.
How are inflation breaths given?
- 5 inflation breaths (lasting 2-3 seconds each) are given to stimulate breathing and heart rate
- if there is no heart rate response or chest movement, recheck mask size and technique, check for chest movements
- give 5 more inflation breaths
- if heart rate not improving and under 50bpm, start compressions and ventilation breaths at a rate of 3:1
When performing inflation breaths, what should be used?
- Air should be used in term babies or near-term babies.
- A mix of air and oxygen should be used in preterm babies (up to 30% FiO2).
- O2 saturation can be monitored throughout resuscitation, aiming for a gradual rise not exceeding 95%.
When should chest compressions be used?
Chest compressions should be used if the heart rate remains below 60 bpm despite resuscitation and inflation breaths. They are performed at a 3:1 ratio with ventilation breaths.
What does prolonged hypoxia increase the risk of?
Prolonged hypoxia increases the risk of hypoxic-ischaemic encephalopathy.
What can be used in severe situations?
- IV drugs (adrenaline and glucose) and intubation can be used.
- Babies near or at term that have possible HIE may benefit from therapeutic hypothermia with active cooling.
What does delayed clamping of the umbilical cord allow and what is this known as?
Delayed clamping of the umbilical cord allows a significant volume of fetal blood in the placenta to enter the circulation of the baby. This is known as placental transfusion.
What are the benefits of delayed umbilical cord clamping?
Benefits include improved hemoglobin, iron stores, and blood pressure, as well as a reduction in intraventricular hemorrhage and necrotizing enterocolitis.
What is the negative effect of delayed umbilical cord clamping?
The negative effect is an increase in neonatal jaundice, potentially requiring more phototherapy.
How long should there be a delay in umbilical cord clamping?
Uncompromised neonates should have a delay of at least 1 minute in the clamping following birth. Neonates that need resuscitation should have it clamped sooner to prevent delays in getting the baby to the resus team.
