Neonatal Resuscitation

Question 1

What is the required rapid initial evaluation for all newborns

Answer 1

Term?
Tone?
Breathing or Crying?

Question 2

Next step if newborn baby is not term, has poor tone or is not breathing or crying?

Answer 2

Brought to radiant warmer for the initial steps of newborn care

Question 3

What are the five initial steps of newborn care

Answer 3

provide warmth
position the head and neck
clear secretions
dry
stimulate

Question 4

After initial steps of newborn care (warmth, position, secretions, dry, stimulate), what are further decisions based on?

Answer 4

Breathing and heart rate

Question 5

At what point is a pulse oximeter or electronic cardiac (ECG) monitor be placed on a newborn baby?

Answer 5

If heart rate cannot be determined by listening with a stethoscope and baby is not vigorous

Question 6

What should be used to confirm you perception of persistent central cyanosis, if you are giving supplemental oxygen to an newborn baby?

Answer 6

Target oxygen saturation table to guide oxygen therapy NOT the appearance of cyanosis

Question 7

When is CPAP helpful in a newborn baby?

Answer 7

When breathing and heart rate is at least 100 beats/min, but respirations are labored or the oxygen saturations remains below the target.

Question 8

After completing the initial steps, under what circumstances is positive-pressure ventilation indicated

Answer 8

Not breathing OR Gasping OR <100 beats/min OR oxygen not at target with free flow air

Question 9

Initial oxygen percent for baby on PPV equal to or greater than 35 weeks gestation

Answer 9

21%

Question 10

Initial oxygen percent for baby on PPV less than 35 weeks gestation

Answer 10

21-30%

Question 11

Ventilation rate for PPV for newborn

Answer 11

40-60 breaths per minute

Question 12

Initial ventilation pressure for PPV of a newborn

Answer 12

20-25 cm H2O

Question 13

Most important indicator of successful PPV is

Answer 13

a rising heart rate

Question 14

When to check heart rate after starting PPV in a newborn

Answer 14

15 seconds

Question 15

When are ventilation corrective steps started in a newborn

Answer 15

If heart rate does not increase after 15 seconds of PPV and no chest movement

Question 16

What are the ventilation corrective steps if heart rate does not increase after 15 seconds of PPV and no chest movement for a newborn

Answer 16

MR. SOPA

M: Mask adjustment
R: Reposition the head

S: Suction mouth and nose
O: Open the mouth
P: Pressure increase
A: Alternative airway

Question 17

What is the pressure increase in ventilation corrective steps for a newborn with no increase in HR after PPV

Answer 17

5-10 cm H2O increments to maximum of 40

Question 18

When can PPV be discontinued in a newborn (reducing rate and pressure)

Answer 18

HR continuously above 100 with spontaneous breathing

Use CPAP or free-flow air to maintain oxygen after if needed

Question 19

When is orogastric tube used with newborn on continuous CPAP or PPV?

Answer 19

after 10 minutes of use

Question 20

Appropriate laryngoscope blade for a term newborn is size

Answer 20

No. 1

Question 21

Appropriate laryngoscope blade for a preterm newborn is size

Answer 21

No. 0

Question 22

How to determine endotracheal tube insertion depth (cm)

Answer 22

NTL (distance from nasal septum to ear tragus) + 1 cm or gestational age (add decimal)

Question 23

When are chest compression indicated in a newborn

Answer 23

HR remains < 60 despite 30 seconds of PPV, but if chest is not moving with PPV don’t start compression, focus on effective ventilation

Question 24

Compression to breaths ratio for newborn resuscitation

Answer 24

3 compression to 1 breath

Rhythm: “one-and-two-and-three-and-breath-and”

Question 25

When to discontinue compressions during resuscitation of a newborn

Answer 25

If HR is > 60, but continue breathing

Question 26

When is a newborn given epinephrine with resuscitation

Answer 26

HR < 60 after - At least 30 sec successful PPV - And another 60 seconds chest compressions with PPV (100% O2)

Question 27

Newborn epinephrine concentration for resuscitation

Answer 27

0.1 mg/mL

Question 28

Newborn epinephrine intravenous or intraosseous dosage for resuscitation

Answer 28

0.1 - 0.3 mL/kg may repeat every 3-5 minutes

Question 29

Newborn epinephrine endotracheal dosage for resuscitation

Answer 29

0.5 - 1.0 mL/kg

Question 30

Volume expansion recommendations for newborn resuscitation

Answer 30

NS or type-O Rh-negative blood | 10 ml/kg over 5-10 minutes

Question 31

Post-resuscitation care of a newborn infant, need what type of close monitoring

Answer 31

``` Respiratory effort Oxygenation Blood pressure Blood glucose Electrolytes Urine output Neurologic status Temperature ```

Question 32

Where on newborn baby is pulse oximeter placed

Answer 32

right hand

Question 33

Type of bag that do not require a compressed gas source

Answer 33

Self-inflating bags

Question 34

Type of bag that cannot be used to administer free-flow oxygen reliably through the mask

Answer 34

Self-inflating bags

Question 35

The type of bag that cannot be used to administer CPAP to a spontaneously breathing baby

Answer 35

Self-inflating bags

Question 36

Type of breather that require a compressed gas source

Answer 36

Flow-inflating bags and T-piece resuscitator

Question 37

Type of bag that must have a tight seal to inflate

Answer 37

Flow-inflating bags

Question 38

Type of bags that use a flow-control valve to regulate the peak inspiratory pressure (PIP) and positive-end expiratory pressure (PEEP)

Answer 38

Flow-inflating bags

Question 39

Type of device that can be used to administer free-flow oxygen through the mask

Answer 39

Flow-inflating bags and T-piece resuscitators

Question 40

What type of breathing devices be used for newborns for administration of CPAP to a spontaneously breathing baby

Answer 40

Flow-inflating bags

Question 41

For babies weighting less than 1,000 g, the endotracheal tube diameter size should be

Answer 41

2.5 mm

Question 42

Suspect what if a baby fails to improve despite resuscitative measures or suddenly develops severe respiratory distress

Answer 42

Pneumothorax

Question 43

Suspect what if a newborn has respiratory distress and generalized edema (hydrops fetalis)

Answer 43

Pleural effusion

Question 44

Robin sequence

Answer 44

abnormalities such as small lower jaw (micrognathia), a tongue that is place further bak than normal (glossoptosis), and blockage (obstruction) of the airways

Question 45

Respiratory distress associated with the Robin sequence can be improved by

Answer 45

Placing the baby prone and inserting small endotracheal tube (2.5 mm) into the nose so the tip is in the pharynx

Question 46

If a small endotracheal tube does not improve respiratory distress of a newborn with Robin sequence, what is next step

Answer 46

A laryngeal mask may provide a lifesaving airway. (endotracheal intubation is frequently difficult)

Question 47

How to improve respiratory distress associated with bilateral choanal atresia

Answer 47

Inserting modified feeding nipple or pacifier with the end cut off into the baby's mouth, an endotracheal tube into the mouth with the tip in the posterior pharynx, or an oral (Guedel) airway

Question 48

If a congenital diaphragmatic hernia is suspected for a delivery, what should be avoided following delivery

Answer 48

Avoid prolonged PPV with a face mask

Question 49

If a congenital diaphragmatic hernia is suspected for a delivery, what is first step after delivery

Answer 49

Quickly intubate the trachea in the delivery room and insert an orogastric tube with suction to decompress the stomach and intestines

Question 50

Potential benefits of delayed cord clamping for preterm newborns include

Answer 50

``` Decreased mortality Higher blood pressure and blood volume Less need for blood transfusion after birth Fewer brain hemorrhages Lower risk of necrotizing enterocolitis ```

Question 51

Indications for volume expansion for newborn after resuscitative efforts that included intubation, chest compression, and IV epinephrine

Answer 51

persistently low heart rate that does not respond to previous mentioned things

Question 52

After chest compression with coordinated ventilations are started in a newborn, the heart rate should be assessed (time)

Answer 52

After 60 seconds

Question 53

When is heart rate assessed again after epinephrine administration in a newborn

Answer 53

1 minute