Flashcards in Neonatal Resuscitation Deck (13)
Discuss the differences in the lungs and circulation between the fetus and after delivery.
The airways and the alveoli must be cleared of fluid to allow adequate gas exchange.
Pulmonary blood flow must increase and spontaneous respirations must be established
An increase in systemic vascular resistance following clamping of the cord in combination with decreased pulmonary vascular resistance leads to functional closure of the ductus arteriosus
It is issues with this transition which leads to the apnoeas and the need for resuscitation.
What is primary apnoea following the birth of a baby?
•Rapid attempts to breathe
•Heart rate decreases
•BP usually maintains and can increase a bit
o Increase blood flow to the brain
•Responds to stimulation
o Rub them a little and then the baby will start to breath
What is secondary apnoea following the birth of a baby?
•No response to stimulation
•When a baby comes out --> assume secondary after drying the baby.
o Give the baby respiratory support
•Take big but irregular gasping breathes to establish lung volume --> then will stop breathing and this is when HR drops and BP drops --> need to get the baby back to the breathing end because if they go into secondary apnoea then its game over.
o This occurs over a 10-20 min period. Need to do something about the secondary apnoea because babies will not get out of it. Dry the baby, tactile stimulation and no breathing then you have to give the baby respiratory support
What is an APGAR score and what are its components?
A = Appearance (Colour)
P = Pulse (HR)
G = Grimace (Irritability)
A = Activity (tone)
R = Respiratory (Respiratory Effort)
What are the scores for each of the components?
A = Appearance (Colour) = Blue,pale – Body pink, extremities blue – complete pink
P = Pulse Rate = Absent - 100/min
G = Grimace (irritability) = No response – Grimace – Cough/Cry
A = Activity (Tone) = Limp – Some flexion of extremitis – Active motion
R = Respiratory (Respiratory Effort) = Absent – slow,irregular – cough/cry
When do you assess APGAR scores? Do you wait for the APGAR score to commence resuscitation?
Assess APGAR at 1min and 5min.
DO NOT wait to assign APGAR score to begin resuscitation
What are the 5 signs of a compromised newborn?
-The baby is not crying
-The baby is not breathing or gasping
-The baby is very floppy
-There is bradycardia
-There is persisting cyanosis
What are the main steps involved in the initial resuscitation prior to the ABC?
Anticipation: Maternal Hx, Obs Hx (pregnancy, labour, delivery)
Warm + Dry the newborn (radiant heater, warm towels)
Position and clear the airway (“sniffing” position)
Stimulate the infant: rub the lower back gently or flick soles of feet
Assess the breathing and heart beat
What are the ABCs and what are the main points of this part of the resuscitation?
-Decide if the baby is vigourous (strong resp effort, good muscle tone, HR>100) or not vigourous
-If vigourous – no further resuscitative interventions required
-If not vigourous – intubate and suction trachea while monitoring vital signs.
What are some signs of correct positioning of the endotracheal intubation?
-Colour change on the CoO2 detector
- Seeing the ETT passing through the larynx
-Improvement in SpO2 and HR
-Chest rises with each breath
-Breath sounds over both lung fields
-No gastric distension with ventilation
-Vapor condensing on the inside of the tube during exhalation
How do you manage the temperature in a newborn and why is this important?
Important because hypothermia can increase O2 consumption and impede effective resuscitation
Keep an ambient temperature of 26 degrees, use polythene sheet or bag for babies
What are the 3 medical interventions that can be used if necessary in a neonatal resuscitation?
Adrenaline – If HR