Neonatal resuscitation Flashcards Preview

Obstetrics and Gynaecology > Neonatal resuscitation > Flashcards

Flashcards in Neonatal resuscitation Deck (26):
1

Initial assessment of all neonates

1. Term or preterm?

<28 weeks, <1500g polyethylene wrap + heat source

2. Good tone? Floppy? Not moving, extended posturing?

3. Are they crying? 20 seconds stimulation - cool room, drying

If not crying, <100bpm first response

4. ABC

5. Temperature, handling and skin protection, pulse 02

2

Preparation for specific conditions: preterm, meconium stained, antenatal airway problem, multiples, diagnosis of defect not compatible with life

1. Preterm <28 weeks, <1500g

Prepare polyethylene wrap (bag with square hole), heat source, dry, hat

2. Born through meconium aspirate 

Connect large bore suction catheter before stimulated to breathe. Prepare suction for vocal cords under direct vision should the iinfant be depressed at birth

 3. Antenatal diagnosis airway

Have LMA, guedel, anaesthetics

4. Not compatible with life

Couselled prior to birth

Decision about treatment

3

Airway

1. Supine

2. Head neutral

3. Clear airway, may need 10/12 G

4. Stimulate to breathe

5. Keep warm

6. Assess breathing and HR

4

Breathing

1. Reassess breathing and HR 

Xbreathing, HR <100 w/ poor muscle tone, breathing ineffectively-->PPV indicated at rate of 40-60 inhalation per minute air (21%) initially for term infants   or 30% oxygen for very preterm infants who are less than 32 weeks gestation, <1500g

Use T piece, self inflating bag, flow inflating bag

 2. Apply pulse oximeter to right hand or wrist->titrate oxygen accordingly for >90%

3. Reassess after 30 seconds of effective positive ventilation

4. Consider goals for 02 saturations

After 1min pre-ductal 02 sats 60-70%

By 3-->70-90

By 10-->85-90

N to be cyanotic for first few mins

If breathing, >100HR dont need 02 to pink em up

5

Circulation

1. HR 60-100 maintain ppv until HR >100 and breathing spontaneously and effectively

2. If <60

Star external compression and PPV 3: 1 

+Fi02 to 100%

Reassess after 30 seconds of effective PPV, EC

3. Remains <30->need advanced resuscitation

4. When >60 External chest compressions can cease, 40-60 inhalations of PPV until >100 and breathing effectively 

6

Drugs

1. <60 BPM after ECC and PPV for 1 minute-->Venous access, adrenaline indicated
10-30mcg/kg (0.1-0.3ml/kg  of 1:10 000 solution, 0.1mg/ml or 100mcg/ml) Rapid bolus with saline flush

2. Use three way tap through umbilical vein- flush with saline

3. Volume expanders

Saline or Rhesus negative O blood, 10ml/kg if shock/blood loss cause

 

7

DIsorders of transition

1. Before / during

Compromised blood flow

Antepartum hemorrhage

Placental abruption

Cord prolapse

Cord compression

Cord tight around neck

Maternal pre-eclampsia

Uterine rupture

2. At time of birth

Failure to breath

Lungs not aerated

8

Considerations that ventilation not effective

1. Bradycardia

2. Depression of respiratory drive

3. Blood pressure falls

4. Cyanosis >10 minutes, poor muscle tone

9

Causes of failure to breath at birth

1. Airway obstruction

Meconium, cartilage, laryngeal web, malformation, failure of lungs to form properly

2. Preterm

-ve hydrostatic pressure to force liquid from alveolar

3. Birth injury

Cervical spine

IU infection

NM disorders

4. Air leak

Pneumothorax from PPV

5. Effects of maternal drugs

Magnesium sulphate, Narcotics, C section

10

Air or oxygen for term and preterm

1. Term: air 21%

2. Preterm 21-30%

11

T piece: initial settings and set up

1. Initial

10L/min

Max pressure 50cm H20 PIP--> 30cmH20 for term newborm, 20-25cm H20 preterm

Peep 5-8 cm/H20

2. Gas supply

Inlet to supply line, oulet to patient supply

3. Attach, test, turn gas flow to 10L, set max pressure to 50cmH20

4. Set PIP, set PEEP

5. Good seal on face

6. Check seal

Look, listen, soft whistle, PEEP 5cm on manometer,  PIP of 30 may be reached on manometer despite face leak up to 90%

7. If -ve HR +PIP by increments of 5-10cmH20

8. If >100, good chest wall movements->decrease PIP by 5cmH20

12

Benefits of T piece, trouble shooting

1. Consistent PIP and PEEP

2. Xachieveing set PIP-> Check seal, reposition head. consider intubation

3. X desired PIP and PEEP after checking with test lung

Check flow rate 8-10L gas flow

Check max pressure release and adjust if needed

13

If signs of poor ventilation with face mask->consider

1. Seal

2. Head position

3. Pressure

4. Gas supply, flow rate

14

Options for ventilation

1. T piece

2. Self inflating

3. Flow inflating

15

Features of self inflating bag: set up, limitations

1. Choose correct size (240ml, TV = 5-10ml/kg) 2. Choose correct mask 3. Assemble bag and mask 4. Test functionality air out, lips open, pressure releif valve max pressure(not accurate) 35-45, connect 02 source, ensure inflates 5. Create good seal 6. Continually reasses ventilation technique= >100HR, rise and fall of chest, +oxygenation

16

Maternal Risk factors for new born to require resuscitation

1. Maternal

Heavy sedation

Previous neonatal death

No antenatal care

Size/date discrepance

Young, >35

Substance use

Drugs, Fever, illness, chorioA Poly/oligoH, PROM >18 hours, Bleeding in 2/3, HTN, DM, Anemia

17

Fetal Risk factors for new born to require resuscitation

1. Fetal

Congenital

IU infection

Perinatal infection

Multiples

41 weeks

LGA, FGR

Rhesus/isoimmunisation

-ve fetal movements before labour

18

Intrapartum Risk factors for new born to require resuscitation

1. Intrapartum

Non-reassuring CTG

Abnormal positioning

Prolapsed cord

Prolonged labour

Prolonged 2nd stage

Precipitate labour (rapid expulsion, may not be aseptic)

Antepartum hemorrhage

Meconium in amniotic with non-reassuring CTG

Narcotics to mother w/i 4 hours of delivery

Forceps/vacuum assisted delivery

19

Overview of post resuscitation care

1. Monitoring

2. Assess need for NICU/special care

3. Blood glucose

4. Antibiotics

5. Induction of hypothermia for hypoxic-ischemic encephalopathy

6. ?Interhospital transfer->Speak with QLD emergency medical systems coordination centre

7. Continuing care of family

8. Management of fluid and electrolytes

9. Imaging if needed >30%, oxygen required at 6 hours, ETT->CXR w/i 1 hour Assists diagnosis: HMD, TTN, congenital anomalies, pulmonary hypoplasia, pneumothorax, air leaks

20

Monitoring post-resuscitation

1. Oxygen saturation

2. Heart rate

3. Respiratory rate and pattern

4. Blood glucose

5. Blood gas, FBC, UEC

6. Fluid balance and nutrition

7. BP, temperature, neurological

8. Check placenta

21

Define mild hypothermia, moderate hypothermia and severe, how to warm

1. Mild hypothermia 36-36.4 2, Moderate 32-35.9 3. Severe

22

Effects of hypothermia

1. ++Metabolic rate 2. ++Oxygen consumption 3. +Glucose utilisation

23

Fluid requirements in first 24 hours

1. 60ml/kg/day

2. 10% glucose

3. BW X 60/24

Sodium and potassium usually not required in the first 24 hours

24

Features suggestive of hypoxic-ischemic encaphlopathy

1. -ve activity. 2. decorticate/decerebrate, 3. hypotonia. 4. poor/no reflex 5. brady, apnoeic, dilated pupils Risks 1. induction 2. >35, >1800g,

25

Monitoring of glucose

1. Check BGL asap after resus.

Initially check from UVC w/i first hour, confirm with true blood glucose

2. Maintain >2.5

3. Avoid large boluses of>100=200mg/kg

4. 1ml 10% glucose contains 100mg glucose

26

What is advanced resuscitation

1. UVC (0.1-0.3ml/kg)

2. IV

3. IO

4. ETT (0.5-1ml/kg) W/ adrenalin