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NLS > NLS > Flashcards

NLS Flashcards

1
Q

Why is delivery through the birth canal an anoxic event?

A

Respiratory exchange by the placenta is interrupted for the 50-75 second duration of the average contraction

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2
Q

For how long can the heart of the newborn baby function despite anoxia?

A

20-30 mins

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3
Q

When does fluid resorption in the neonates lungs begin?

A

During labour

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4
Q

How much fluid do babies born vaginally at term still have in their lungs?

A

100ml

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5
Q

What proportion of babies born at term will initiate spontaneous respirations?

A

85% - within 10-30 seconds

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6
Q

What is the crucial intervention in NLS?

A

The aeration and ventilation of babies

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7
Q

How quickly will the remaining fluid in the average 3.5kg baby be cleared from the lungs?

A

Within a matter of minutes, unaided

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8
Q

How much warmer is the human fetus than its mother?

A

0.5 oC

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9
Q

How low can a baby’s temperature fall within 5 minutes if left naked and wet?

A

33 oC

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10
Q

By what degree does risk of mortality increase in very low birth weight babies for every 1 oC below the 36.5 oC baseline?

A

28%

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11
Q

What should be assessed in the baby whilst the umbilical cord is still attached?

A

Colour
Tone
breathing
Heart Rate

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12
Q

How should colour be assessed in a newborn?

A

By looking at the trunk, lips and tongue

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13
Q

Is the cord pulsation a reliable indicator of heart rate?

A

If >100 pulsations a minute - likely all i well, but if pulsations less than this, it is not necessarily an indicator of true heart rate, and thus should be assessed with a stethoscope

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14
Q

What is the fetal circulation fed by?

A

Both the right and left ventricle - 55% by the right ventricle, 45% by the eft ventricle

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15
Q

What is the combined ventricular outfit in the near-term fetus?

A

465ml/kg

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16
Q

75% of the right ventricle output supplies what?

A

Through the ductus arteriosus to supply the abdomen, lower body and placenta

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17
Q

75% of the left ventricle output supplies what?

A

Perfuses the upper body - the head, neck and arms

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18
Q

What is the total fetal lung fluid in a near-term infant?

A

20-30ml/kg (equivalent of functional residual capacity)

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19
Q

What would happen should there be insufficient amniotic fluid (and thus fetal lung fluid)?

A

Adversely affected fetal lung development, causing pulmonary hypoplasia

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20
Q

What is it about labour that bring about the cease in production of lung fluid secretion from the fetus’s alveolar cells?

A

Adrenaline production by the fetus

Thyrotropin production by the mother

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21
Q

What is it that bring about loss of fetal lung fluid?

A

Primarily = the hydrostatic pressures generated by inspiration + secondarily, postural changes imposed on the fetus during uterine contractions > than the ‘vaginal squeeze’ affect

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22
Q

How do the hydrostatic pressures generated by inspiration work?

A

Spontaneous inspiratory movements by the fetus generates a transepithelial pressure gradient between the interstitial tissue and airway lumen, the lung fluid being drawn from the proximal airways into the distal ones, which is then cleared across the distal airway wall into the surrounding interstitial tissue space

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23
Q

How many breaths is it before gas exchange typically occurs?

A

7 - before carbon dioxide is detected on exhalation

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24
Q

When does exhaled carbon dioxide peak after birth?

A

Within the first 2-3 minutes of birth

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25
Q

Why do newborns recover from periods of oxygen deprivation more so than adults?

A
  1. Conservation of energy by shutting down circulation to all but vital organs in response to hypoxia
  2. Activity of automatic spinally generated gasping activity following primary apnoea
  3. Anaerobic respiration, the newborn’s heart utilising glycogen, as an alternative fuel to maintain circulation
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26
Q

At what saturation would you NOT start inspired oxygen?

A

> /=95%

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27
Q

At <28/40 gestation, what concentration of inspired oxygen would you start with?

A

30%

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28
Q

At 28/40-32/40 gestation, what concentration of inspired oxygen would you start with?

A

21-30%

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29
Q

At >32/40 gestation, what concentration of inspired oxygen would you start with?

A

21%

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30
Q

How long minimum of adequate ventilation should be performed before chest compression be started if inadequate HR?

A

30 seconds

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31
Q

What concentration of oxygen would you give if chest compressions need to be started?

A

100%

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32
Q

What are the acceptable R arm saturations 2 minutes after birth?

A

65%

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33
Q

What are the acceptable R arm saturations 5 minutes after birth?

A

85%

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34
Q

What are the acceptable R arm saturations 10 minutes after birth?

A

90%

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35
Q

What is the usual HR in term and well pre-term babies after 2 mins?

A

> 100

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36
Q

What are the different methods of assessing heart rate during resuscitation?

A

Stethoscope
Pulse oximetry
ECG monitoring

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37
Q

Why are oximetry readings take in the R arm of newborn infants?

A

Measurements are pre-ductal. Pre-ductal saturations represent the oxygen going to the brain

38
Q

What pressures of inflation should be started with with a term infant for inflation breaths?

A

30cm of water, 2-3 seconds inspiratory time

39
Q

What pressures of inflation should be started with with an infant <32/40 for inflation breaths?

A

25cm of water

40
Q

At what rate should ventilation breaths be performed?

A

30 breaths/minute, 25cm of water, 1 second inspiratory time

41
Q

What response suggests the infant had been suffering with terminal apnoea?

A

Gasping in nature

42
Q

How long does it usually take for the heart to respond to chest compressions?

A

Usually, only 20-30 seconds

43
Q

How is access achieved in a newborn infant?

A

Umbilical vein catheter or IO

44
Q

How often should adrenaline be given if CPR is be performing?

A

Every 3-5 minutes

45
Q

What may be going on if the HR is still not improving after CPR?

A

Hypovolaemia
Tension pneumothorax
Diaphragmatic hernia
Complete heart block

46
Q

What are the fetus antenatal RFs for neonatal resuscitation at delivery?

A
  • Prematurity
  • IUGR
  • Multiple pregnancy
  • Serious congenital abnormality
  • Oligo/poly-hydramnios
  • Fetal anaemia, including hydrops
47
Q

What are the maternal antenatal RFs for neonatal resuscitation at delivery?

A
  • High BMI
  • Short stature
  • PET
  • Lack of intrapartum steroids in pre-term
  • PIH
  • GDM
  • Maternal sepsis
48
Q

What are the intrapartum RFs for neonatal resuscitation at delivery?

A
  • Evidence of fetal compromise - e.g. pathological CTG
  • Meconium-stained liquor
  • Vaginal breech
  • Instrumental delivery
  • Significant maternal PPH
  • C-section before 39/40
  • Emergency section
  • GA
49
Q

What is near enough the only condition that requires early intubation?

A

Congenital diaphragmatic hernia

50
Q

What special consideration should be given to neonates with abdominal wall defects?

A
  • Passing an NG tube when positive pressure ventilation is required in order to minimise intestinal distension
  • IO may be required for access as umbilical vein catheterisation may be impossible
51
Q

What can be done in relation to the umbilical cord if DCC is not practicable, but immediate cutting is not required?

A

Cord milking

52
Q

At what gestation should cord milking NOT be performed?

A

<28 weeks gestation

53
Q

What are the benefits of DCC in a term infant?

A
  1. Avoidance of bradycardia
  2. Improved early haematological; indices
  3. Improved iron stores in infancy
54
Q

What are the benefits of DCC in pre-term infants <34/40?

A
  1. Improved survival
  2. Improved early haematological indices
  3. Improved cardiovascular stability in first 24 hours - improved BP and lower use of inotropes
  4. Reduce need for blood transfusions and reduced total number of transfusions
55
Q

When may DCC NOT be advisable?

A
  1. Cases with interruption of the placental blood flow/oxygenation - e.g. maternal haemorrhage/seizure/arrest, placental abruption, vasa praevia, cord avulsion
  2. TTTS
  3. Fetal hydrops, any underlying cause
56
Q

How much additional blood is conveyed to the infant during cord milking?

A

3-5 ‘milks’ = 50ml

57
Q

What are the reasons for difficulties with breathing at birth?

A
  1. Loss of respiratory drive
  2. Mechanical obstruction of airway
  3. Inability to breathe
58
Q

What causes a loss of respiratory drive in neonates?

A

Congenital brain abnormality

Acquired depression of the neurological centres - e.g. infection, drugs, perinatal stress and hypoxia

59
Q

What causes a mechanical obstruction of the airway in neonates?

A

Foreign body - e.g. mec or vernix
Anatomical abnormality of the airway - Pierre-Robin sequence
Loss of muscular tone affecting patency of the airway - unconscious baby

60
Q

What causes an inability to breathe in neonates?

A

Neurological and muscular disorders

Lung immaturity

61
Q

What are the 2 manoeuvres that open a neonate’s airway?

A
  1. Head in neutral position, supporting chin and jaw

2. Moves the jaw forward using a two-handed jaw thrust

62
Q

How can the head be kept in a neutral position without holding it?

A

There is a tendency for the neonates neck to be flexed due to the prominence of the occiput - this can be overcome, holding the head in neutral position by a 2cm pad being placed under the shoulders

63
Q

Which pieces of equipment can be used to deliver positive pressure ventilation?

A
  1. T-piece
    or
  2. Self-inflating bag
64
Q

How do you minimise face mask leaks?

A

3 P’s:
POSITION - rolling the mask on to the face
PRESSURE - balancing the pressure exerted on the mask by the finger and thumb
PULL - lifting or pulling the jaw up in to the mask

65
Q

What size face mask should be used for 23-26/40?

A

35mm

66
Q

What size face mask should be used for 27-28/40?

A

35mm or 42mm

67
Q

What size face mask should be used for 29-32/40?

A

42mm

68
Q

What size face mask should be used for 33-36/40?

A

42mm or 50mm

69
Q

What size face mask should be used for 37/40?

A

50mm

70
Q

What size face mask should be used for term IUGR/38 weeks?

A

50mm or 60mm

71
Q

What size face mask should be used for >39/40 or LGA?

A

60mm

72
Q

When would you expect the chest to start moving on giving inflation breaths?

A

4th or 5th breath

73
Q

If needed, at what rate should ventilation breaths be given?

A

30/min

74
Q

When can an iGel or LMA be used?

A

In those >2000g or >34/40

75
Q

What size laryngeal mask (LMA or iGel) should be used in neonates, and how should it be inserted?

A

Size 1

Should be inserted with a laryngoscope (unlike in adults)

76
Q

How should the head be positioned when inserting a laryngeal mask?

A

With the neck in a slightly extended position

77
Q

What do you do if inflation breaths do not work?

A

Consider obstruction - consider using laryngoscope to inspect the oropharynx and a large bore suction catheter to relieve the obstruction

78
Q

What are intubation rates in neonates in the UK?

A

0.4-2%

79
Q

What are the chest compression rates in neonates in the UK?

A

0.3%

80
Q

What proportion require adrenaline?

A

0.05% - 1 in 2000

81
Q

What is the technique for two-thumbed chest compressions?

A

Overlapping thumbs, lower third of the sternum, in the centre of the chest, just below the imaginary line between the nipples

82
Q

At what rate should CPR be performed in neonates?

A

3:1 - 90 chest compressions:30 breaths (120 events)/minute

83
Q

What drugs should be given with prolonged resuscitation?

A

Glucose and sodium bicarbonate

84
Q

How often should adrenaline be given whilst CPR is ongoing?

A

Every 3-5 minutes

85
Q

What is the preferred route of adrenaline in neonates?

A

IV, but IO can be used

86
Q

What is the recommended dosage of adrenaline IV or IO in resuscitation?

A

20 microgram/kg

87
Q

What is the recommended dosage of adrenaline when given intra-tracheally in resuscitation?

A

100 microgram/kg

88
Q

What level of CPAP should be used to stabilise pre-term infants if needed?

A

5-8cm water

89
Q

What is the appropriate PEEP for a ventilated pre-term infants if needed?

A

5cm

90
Q

What is the first sign of recovery from terminal apnoea?

A

Once the circulation is restored, agonal gasps, occurring every 5-8 seconds is the first sign

91
Q

What is the cause of primary apnoea?

A

Unclear airway

NLS (1 decks)

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