Newborn Resuscitation

Question 1

Recite the Newborn Resuscitation CPG

Part 1

Answer 1

Question 2

Recite the Newborn Resuscitation CPG

Part 2

Answer 2

Question 3

What should be done immediately after birth?

Answer 3

Maintain warmth and stimulate the baby.

Question 4

How should a term or preterm (32–42 weeks) baby be managed for warmth?

Answer 4

Skin-to-skin contact, dry, beanie.

Question 5

How should a very preterm baby (<32 weeks) be managed?

Answer 5

Leave wet, use a polyethylene bag, dry the head, apply a beanie.

Question 6

How should a very preterm, unresuscitated baby (<32 weeks) be managed?

Answer 6

Dry, use a polyethylene bag and beanie.

Question 7

What signs indicate that a newborn is breathing adequately with good muscle tone?

Answer 7

• Breathing/crying
• Flexed arms and legs

Question 8

What is the action if the baby is breathing adequately with good tone?

Answer 8

Manage as per CPG N0101 Newborn Baby.

Question 9

What is the first step if the newborn is apnoeic, gasping, or has poor muscle tone?

Answer 9

Position and move to a resuscitation area.

Question 10

What airway position is recommended?

Answer 10

Neutral airway position with a towel under the shoulders.

Question 11

When should suction be performed?

Answer 11

Only if airway obstruction is suspected.

Question 12

What should continue during this assessment?

Answer 12

Drying/stimulating (for no more than 30 seconds).

Question 13

What three signs are assessed at this stage?

Answer 13

• Breathing/crying
• Muscle tone
• Heart rate (via auscultation)

Question 14

What ventilation rate is used for IPPV?

Answer 14

40–60 breaths per minute on room air.

Question 15

What PEEP level is used?

Answer 15

5 cm H₂O.

Question 16

List at least 4 IPPV troubleshooting measures.

Answer 16

• Mask size and fit
• Chin lift, open mouth
• Neutral airway position
• Two-person BVM technique
• Increase inspiratory pressure
• Swap operators
• Consider suction (if airway occlusion suspected)

Question 17

What actions should be taken alongside IPPV?

Answer 17

• Escalate care / PIPER via AV Clinician
• Apply SpO₂ monitor (right hand or wrist)
• Apply ECG monitoring if available (not for <28 weeks)
• Reassess after 30 seconds

Question 18

What is the compression to ventilation ratio for HR < 60?

Answer 18

CPR at 3:1 ratio with oxygen (5 L/min)

This is the recommended ratio for effective CPR in infants with a heart rate less than 60 beats per minute.

Question 19

When should an SGA be used?

Answer 19

If the baby is ≥ 34 weeks gestation

SGA stands for supraglottic airway, which is used for airway management in infants.

Question 20

When should intubation be considered?

Answer 20

Only if ventilation with SGA is inadequate or SGA is not indicated

Intubation is a more invasive procedure and is reserved for cases where SGA is ineffective.

Question 21

What drug is administered if HR < 60 persists despite ventilation?

Answer 21

Adrenaline 10 mcg/kg IV every 4 minutes

Adrenaline is critical for increasing heart rate and improving cardiac output in neonates.

Question 22

What fluid should be given if HR < 60 persists despite adequate ventilation and adrenaline?

Answer 22

Normal saline 10–20 mL/kg IV (may be repeated once if required)

This fluid helps to support blood volume and circulation.

Question 23

What glucose-related action should be taken if HR < 60 persists?

Answer 23

Assess BGL (do not delay transport)

BGL stands for blood glucose level, which is crucial in managing hypoglycemia.

Question 24

What should be done if BGL < 2.6 mmol/L?

Answer 24

Consult with PIPER for 10% Dextrose or Glucagon administration

PIPER is a pediatric emergency advice service, and hypoglycemia requires prompt treatment.

Question 25

What is the ventilation strategy for HR 60–100 bpm?

Answer 25

IPPV at 40–60 breaths per minute on room air ## Footnote IPPV stands for intermittent positive pressure ventilation, which is a common method of providing respiratory support.

Question 26

When should reassessment occur in the HR 60–100 bpm range?

Answer 26

After 30 seconds if continuous monitoring isn’t already in place ## Footnote Prompt reassessment is essential to monitor the infant's response to treatment.

Question 27

What should be added if HR < 100 persists?

Answer 27

IPPV with Oxygen (5 L/min), SGA if HR < 100 and baby is ≥ 34 weeks ## Footnote This is a critical step to ensure adequate oxygenation and ventilation.

Question 28

How should an infant with HR > 100 be managed?

Answer 28

Monitor closely; commence IPPV if HR drops below 100 ## Footnote Continuous monitoring is essential to ensure the infant remains stable.

Question 29

What should be done if SpO₂ < 90% or breathing is laboured at 5–10 min post-birth?

Answer 29

Discuss with PIPER ## Footnote Early intervention is crucial if oxygen saturation remains low or if the infant is in respiratory distress.

Question 30

What should be done if the newborn is breathing but laboured?

Answer 30

IPPV at 40–60 breaths/min, titrate oxygen (1–5 L/min) if SpO₂ < 90% ## Footnote This approach ensures the infant receives adequate ventilation and oxygenation.

Question 31

What is the oxygen strategy for babies breathing normally but SpO₂ < 90%?

Answer 31

Titrate oxygen 1–2 L/min via nasal prongs, target SpO₂ of 90%, decrease/discontinue oxygen if SpO₂ > 90% ## Footnote This strategy helps to maintain appropriate oxygen levels while preventing hyperoxia.