NNU teaching - resus at birth

Question 1

What happens when babys cry at birth?

Answer 1

• Opens lungs - allows fluid to leave lungs very quickly
• Cord clamping, stimulus of environment triggers this

Question 2

What happens if cord blood supply is interrupted before birth?

Answer 2

• Initial increase in breathing effort and HR
• PaO2 drops - no O2 available and paCO2 and acid rises
• Primary apnoea occurs - no breathing
• HR rapidly reduces but maintains 60 bpm for 10-20 mins (babys are designed for labour)
• Breathing then occurs from primative spinal breathing reflexes - triggered by spine - deep breathes and less frequent
• Terminal apnoea - if no one intervenes –> death

Question 3

Baby delivered during primary apnoea - how to help/reverse

Answer 3

• Inflation breaths to open lungs, if no response then ventilate breaths
• Will begin the breathe and O2 will rise
• Sometimes will not need anything - spinal reflexes may kick in (but not sure when examining if primary or terminal)

Question 4

Baby delivered during terminal apnoea with low HR and BP

Answer 4

• Breathe for them - inflation, ventilation
• May need to aid their circulation too - short and rapid response as only moving blood 3-4cm from lungs to coronarys

Question 5

Resus system of baby

Answer 5

• Dry and cover the baby - most important for mortality
• Assess situation
• Airway
• Breathing - inflation then ventilation breaths
• Circulation - compressions
• Drugs if needed

Question 6

Initial rapid assessment of newborn

Answer 6

• Colour
• Tone
• Breathing
• HR

Question 7

Inflation breathes

Answer 7

• Press bag for 3 seconds in and then rapidly let go
• Make sure you look for chest moving up and down - determine if resp or heart problem
• Do up to 5 and reassess
• Attempting to mimic initial cry

Question 8

Airway problems main cause in baby

Answer 8

• Pharyngeal tone is poor - flop head onto chest
• Not usually foreign body - no need for suction

Question 9

earliest sign of improvement in babys with initial resus

Answer 9

• HR will increase - assess with stethoscope
• Then colour improves, sats improve

Question 10

Another way of helping getting air into chest

Answer 10

• Jaw thrust

Question 11

Ventilation breathes

Answer 11

• Mimic baby breathing
• Normal ventilation
• 30 breaths / min

Question 12

When to do chest compressions?

Answer 12

• Confirm air definitely going in
• Heart rate still not responding

Question 13

Neonate compression to ventilation ratio - right after birth

Answer 13

• 3 compressions to 1 breath in 2 seconds

Question 14

Occasional drugs babys may need at birth if HR not responding

Answer 14

• Adrenaline
• Bicarbonate
• Glucose - used up stores from stress state, gestational
• Sometimes blood - rarely