Flashcards in Newborn: Routine Care and Resuscitation Deck (18)
What are the characteristics of a newborn requiring no additional resuscitation?
-1. A term infant
-2. Clear amniotic fluid with no evidence of meconium and infection
-3. Spontaneous breathing and crying
-4. Good muscle tone
What is the APGAR system?
Objective means to assess newborn condition.
- 5 signs
- scored 0 / 1 / 2 at
- 1 and 5 mins (and every 5 mins until 20 if under 7)
What are the signs assessed by APGAR?
What is indicated by different APGAR scores?
-Apgar 7-10 = infant who requires no active resuscitation
-Apgar 4 - 7 = mild to moderately depressed infant
-Apgar <4 = severely depressed infant requiring immediate resuscitative efforts
What are the components of routine care of the newborn?
-1. Body temp
-2. Umbilical cord
-3. Vital signs
-4. Mother contact
How is newborn body temp maintained?
- thoroughly dry
- warm blankets
- skin to skin contact
If pre term:
- warming pads
- radiant heater
What is transitional care ?
Continued close observation for stabilisation - transition period (6-12h after birth).
- Prophylactic erythromycin or tetracycline to both eyes to prevent gonococcal ophthalmia neonatorum
- Vitamin K
- Monitor voiding pattern and bowel motions
What are the signs of a compromised newborn?
- Not crying
- Not breathing or gasping
- Very floppy
- Persisting cyanosis
What stimulates closure of ductus arteriosus?
- increase in systemic vascular resistance
- decreased pulmonary vascular resistance
= functional closure of DA
Describe use of the Neopuff.
-1. Check gas connected
-2. Use flow rate 10L / min
-3. Set pressures (25 <36w; 30 >36w)
-4. Ensure there is good seal
-5. Ventilate lungs at 40 - 60 breaths / min
-6. Ensure chest wall and upper abdomen moves with each inflation
What is required if no detectable heart beat?
Causes of failure to response post intubation?
- Tube in oesophagus
- Tube too far
- Diaphragmatic hernia
Chest compressions or ventilation more important in neonatal resus?
Describe chest compressions in neonatal resus?
- Pressure to lower half sternum, keep in midline, avoid xyphoid process.
- Compress 1/3 AP diameter chest
- Avoid simultaneous compression / inflation
How may adrenaline be administered to newborn?
- Umbilical vein most rapidly accessible route for fluid and medication administration
- Endotracheal tube (if adrenaline: much larger doses required than standard)
- Peripheral IV line
- Intraosseous access
When is newborn resuscitation discontinued?
No response with measurable HR after 10 mins
Equipment required for anticipated newborn resus?
-1. Radiant warmer on
-2. O2 source open and adequate flow
-3. Suction tested
-4. Laryngoscope functional and light checked
-5. Bag and mask shows adequate seal and pressure