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Nenonate > Test 2 - Neonatal Resuscitation > Flashcards

Test 2 - Neonatal Resuscitation Flashcards

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1
Q

How long can a fetus compensate for in the fetal hypoxia termed fetal stress?**

A

Fetus can compensate for up to 45 minutes of fetal hypoxia termed fetal stress**

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2
Q

How does uteroplacental blood flow produces fetal asphayxia?

A

Any compromise of uteroplacental blood flow produces fetal asphyxia

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3
Q

What is the most common cause of neonatal depression, when it comes to fetal resuscitation?

A

Intrauterine asphyxia is the most common cause of neonatal depression

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4
Q

What is the most important and helpful in identifying distress throughout labor?

A

Fetal monitoring throughout labor is important and helpful in identifying distress

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5
Q

What is the % of false positive rate when it comes to fetal monitoring

A

Alone it has a 35-50% false positive rate

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6
Q

How many weeks are required before starting fetal monitoring on a patient?

A

Required at 24 weeks and above

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7
Q

What are the several parameters that fetal heart rate monitoring must have?

A

Baseline heart rate

Baseline variability

Relationship to uterine contractions
-Deceleration patterns

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8
Q

What is normal fetal baseline heart rate?

A

Normal – 110-160 beats/min

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9
Q

What are some things that can increase fetal heart rate above normal?

A
  • Prematurity
  • Mild fetal hypoxia
  • Chorioamnionitis (infection of the placenta, from pre mature rupture)
  • Maternal fever
  • Maternally administered drugs (anticholinergics or beta agonists)
  • hypothyroid
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10
Q

What are some things that can decrease fetal heart rate below normal?

A
  • Post-term pregnancy
  • Fetal heart block
  • Fetal asphyxia
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11
Q

What is the single MOST important characteristic of FHR?

A

Variability

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12
Q

What does variability represent in terms of the fetal neuro status?

A

Reflects an intact neurological system

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13
Q

What does variability represent in terms of fetal oxygenation?

A

Represents optimal fetal oxygenation

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14
Q

Variability measures fetal oxygenation (BLACK)

A

Measure of fetal oxygenation RESERVE

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15
Q

How is baseline variability best assessed by?

A

Best assessed by scalp electrodes

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16
Q

What is a prominent sign of fetal asphyxia?

A

Sustained decreased baseline variability is a prominent sign of fetal asphyxia

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17
Q

What are some causes of decrease variability for a fetus?

A
  • CNS depressants (opioids, barbiturates, Mg sulfate, benzos)
  • Parasympatholytics (atropine) (decrease the fluctuations)
  • Prematurity
  • Fetal dysrhythmias
  • Anecephaly
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18
Q

Normal fetus displays beat to beat variablity (R wave to R wave), what is defined as a minimal?

A

minimal of <5 beats per minute

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19
Q

Normal fetus displays beat to beat variablity (R wave to R wave), what is defined as moderate?

A

moderate 6-25 beats/min

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20
Q

Normal fetus displays beat to beat variablity (R wave to R wave), what is defined as a marked?

A

marked >25 beats/min

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21
Q

Sinusoidal (mathematical curve that describes a smooth periodic oscillation) pattern is associated with fetal depression, what are three causes?

A

Hypoxia
Drugs
Anemia

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22
Q

Accelerations are defined as?

A

Defined as increases of 15 beats/min or more lasting more than 15 seconds

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23
Q

Periodic increases reflect normal oxygenation and are usually related to what two things?

A

Periodic increases reflect normal oxygenation and are usually related to fetal movement and responses to uterine pressure

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24
Q

Normal fetuses have how many accelerations q hour?

A

Normal fetuses have 15-40 accelerations q hour

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25
The amount of accelerations can decrease q hour, what are some causes?
- Fetal sleep - Drugs (opioids, mg, atropine) - Hypoxia
26
THE ABSENSE OF BOTH BASELINE VARIABILTY AND ACCELERATIONS IS “BLANK” AND MAY BE AN IMPORTANT SIGN OF FETAL COMPROMISE******
THE ABSENSE OF BOTH BASELINE VARIABILTY AND ACCELERATIONS IS “NONREASSURING” AND MAY BE AN IMPORTANT SIGN OF FETAL COMPROMISE******
27
What is the response that causes an early deceleration?
- Early (type I) deceleration are thought to be a response to compression of the fetal head or stretching of the neck during uterine contractions - Generally not associated with distress
28
What is associated with late deceleration?*
Late (type II) -Associated with fetal compromise -Occur at the peak or following the contraction BAD***
29
What is thought to cause a variable deceleration?
Variable (type III) - Most common - Thought to be from cord compression and intermittent decreases in umbilical blood flow
30
What is considered prolonged deceleration patterns?
Associated with fetal asphyxia when they are >60 bpm, last longer than 60 seconds or occur in a pattern that persists for more than 30 minutes
31
How is the fetal scalp pH obtained?
Fetal scalp pH – obtained by making a small puncture in neonate’s scalp and obtaining blood
32
What pH is considered vigorous or depressed neonate?
>7.20 associated with vigorous neonate | <7.20 associated with a depressed neonate
33
When does breathing normally begin for a neonatal patient?
Breathing normally begins 30 seconds and is sustained with 90 seconds
34
What is normal breaths per minute for a neonate?
Normal 30-60 breaths per minute
35
What is normal heart rate for a neonate?
Normal heart rate is 120-160 beats per minute
36
What is normal BP for a neonate that weighs 1-2kg?
50/25 for neonates 1-2kg
37
What is normal BP for a neonate that weighs more than 3kg?
70/40 for >3 kg
38
When should you do an APGAR score to test for survival and neurological outcome?
APGAR scores at 1 (survival) and 5 (neurological outcome) minutes after delivery
39
What are the four causes of persistent pulmonary hypertension?**
Acidosis Hypoxia Hypovolemia Hypothermia
40
What is the time span for a neonate?
Neonate is 1-28 days**
41
What will stimulate the release of surfactant into the alveoli? When the patient goes from intrauterine to extrauterine?
Lung inflation will stimulate release of surfactant into the alveoli
42
What causes the transient tachypnea of the newborn when it transitions from intrauterine to extrauterine?
Caused by retained fluid in the lungs
43
How much fluid does the fetal lung contain when it transition from intrauterine to extrauterine?
The fetal ling contains fluid 30mL/kg
44
During birth, how much fluid is expelled from the lungs in a neonate during delivery?
2/3 expelled from the lungs during delivery
45
During birth, how much fluid is expelled form the lungs in a preterm or delivery through c-section?
Preterm babies and those delivered by C/S will have increased residual lung fluid
46
During the transition from intrauterine to extrauterine life, what happens in response of the catecholamine surge?
- Allows for release of surfactant - Directs flow to vital organs during delivery - Thermoregulation
47
During the transition from intrauterine to extrauterine life, a wet baby will loose heat by:
Conduction Convection Evaporation Radiation
48
What causes neonatal depression?
- Drugs given to mother (anesthetics, opioids, sedatives, and magnesium) - Intrauterine fetal hypoxia and acidosis - High or low environmental temperature - CNS trauma caused by birth process - Congenital anomalies
49
What does APGAR stand for?
``` Appearance Pulse rate Grimace Activity Respiration ```
50
What is a mildly asphyxiated apgar score?
Mildly asphyxiated score 5-7 | -Need stimulation while 100% O2 blown across face
51
What is a moderate asphyxiation apgar score?
Moderate asphyxiation score 3-4 | -Require temporary assisted positive pressure ventilation with mask and bag
52
What is a severe depression apgar score?
Severe depression score 0-2 (not good) | -Immediate intubation and chest compressions may be required
53
Umbilical cord gas and pH analysis reflects the fetal condition immediately before delivery, What does the umbilical artery blood gas represent and what does the umbilical vein reflect?
Umbilical artery blood gas represents the fetal condition Umbilical vein reflects the maternal condition and uteroplacental gas exchange
54
What is normal umbilical cord pH?
Normal umbilical cord pH >7.2 Presence of metabolic acidosis is a more ominous sign than respiratory acidosis
55
Normal arterial values for umbilical cord blood? (pH Pco2 and bicarb)
Arterial pH 7.28 Pco2 49.2 Bicarb 22.3
56
Normal venous values for umbilical cord blood? (pH Pco2 and bicarb)
Venous pH 7.35 Pco2 38.2 Bicarb 20.4
57
Where should you place the pulse oximeter to evaluate the pre-ductal blood flow in a neonate?
Place the pulse oximeter on the right upper extremity for: -Pre-ductal blood flow -Accurate assessment of -CNS oxygenation Place over the right radial artery
58
For neonatal resuscitation, how much of an increase in HR is a reliable sign of effective oxygenation?
An increase in HR above 100 is a reliable sign of effective oxygenation
59
Many infants have respiratory depression caused by opioids given to the mom, what is the dose for Nalaxone?
Nalaxone 0.1mg/kg IV, ET, IO, SQ
60
For neonatal resuscitation, if positive pressure ventilation does not improve oxygenation, what should you do?
Insert an ETT After intubation resume positive pressure ventilation with 100% O2 until the infant is stable -FiO2 should be reduced as soon as possible
61
Chest compressions are preformed when the HR is below what (#) for neonatal resuscitation?
``` HR is below 60. -Ventialtion ratio 3:1 -Rate is 90 per minute Stop compressions when -HR is above 60 -Continue ventilations until HR is above 100 ```
62
For neonatal resuscitation, if baby is experiencing hypovolemia, how much should you give?
NS or LR 10mL/kg over 5-10 mins
63
For neonatal resuscitation, what drug is the treatment of choice for bradycardia?
Epinephrine - used if HR is <60bpm after 30 sec of ventilation and chest compression - repeat every 3-5min
64
For neonatal resuscitation, what drug should you give after a prolonged resuscitation? (this drug is guided by blood gas)
Sodium Bicarbonate
65
Meconium in amniotic fluid occurs in what % of deliveries?
10-12% of deliveries
66
Fetal distress (especially after 42 weeks gestation) is often associated with a release of what into fluid? (for a neonate)
Associated with a release of thick meconium into fluid
67
Neonatal gasping causes the thick fluid to enter the lungs (from trachea to large airways to periphery of lungs), what is the % that severe respiratory distress can occur and what can these infants further develop?
- Severe respiratory distress in 15% | - Even worse these infants can develop persistent fetal circulation
68
What is the treatment for meconium stained neonates?
- Amnioinfusion prior to delivery can reduce severity - Bulb suctioning recommended for thin watery meconium - Intubation and tracheal suction considered if thick meconium present - -3x tracheal suctioning and ETT removed then supplimental O2 with tight fitting mask
69
What are signs of magnesium intoxication? for neonates?
Hypotension, hypotonic, and peripherally dilated - may require intubation and mechanical ventilation - Mg will decrease over 24-72 hours - antidote: Calcium
70
What is the most common metabolic problem in neonates?
Hypoglycemia
71
What is considered the parameter for hypoglycemia in neonates?
When BS is below 45mg/dL in the first 3 days of life | -after 3 days, normal BS is greater than 75-90 mg/dL
72
Neurologic damage can occur if hypoglycemia is not treated, what are some signs?
Lethargy, apnea, cyanosis, seizures, and hypotonia
73
What are some causes of hypoglycemia for a neonate?
Hypoxemia, sepsis, and high levels of circulating insuline
74
For newborn charateristics, cardiac output is dependent on heart rate, why?*
Because stroke volume is relatively fixed - noncompliant LV - Poorly developed LV (faster HR)
75
What are some newborn characteristics for pulmonary status?*
- Lower lung compliance - Greater chest wall compliance - Lower FRC
76
For new borns, what must you do to blood products??****
Cellular blood products must be irradiated to reduce the increase risk of transfusion-associated graft versus host disease(GVHD)
77
For newborns, what is different about the body surface area and total body water content?*
- Higher ratio of body surface area to body weight | - Higher total body water content
78
For newborns, what is different about the tongue, head, nasal passages?*
- Large tongue and head - Narrow nasal passages - Anterior and cephalad larynx
79
For newborns, what is different about the epilgottis, trachea, neck, tonsils and adenoids?*
- Long epiglottis - Short trachea and neck - Prominent tonsils and adenoids
80
For newborns, what is different about the intercostal and diaphragm muscles, and resistance to airflow?*
- Weak intercostals and diaphragm muscles | - High resistance to airflow
81
What is considered newborn or a neonate?*
Newborn first 28 days of life.
82
Why do neonates experience respiratory fatigue faster?****
- The diaphragm has more type II (fast twitch) and less type I fibers (slow twitch)*** - Neonatal diaphragm only has 25% type 1 (adults have 55%). Preterm babies have less than 10%**
83
What is the difference between type I and type II fibers?****
- Type 1 are built for endurance- they are resistant to fatigue - Type 2 are built for short bursts of heavy work- they tire easily

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