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Single most important concept from course?
Ventilation of the baby's lungs is the most important and effective action in neonatal resuscitation.
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What percentage of newborns require some assistance at birth?
10% (90% of newborns are totally fine)
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What percentage of newborns require extensive resuscitative measures to survive?
1%
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3 major changes to allow baby to get oxygen to their lungs
- 1) fluid in the alveoli is absorbed by lymphatics and replaced by air
- 2) umbilical arteries constrict and then the umbilical arteries and vein are closed/clamped.
- 3) blood vessels in the lung relax, decreasing resistance to blood flow
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What allows fetal blood to bypass the lungs in uteri?
The patent ductus arteriosus (less resistance than the pulmonary arteries, so blood bypasses the lungs)
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Problems that may disrupt normal transition to get O2 in their lungs?
- Lungs may not fill with air - inadequate ventilation
- Pressure may not rise as expected (hypotension)
- Pulmonary arterioles may stay constricted after birth (persistent pulm hypertension of newborn)
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*If a baby does not begin breathing immediately after being stimulation, he or she is likely in secondary apnea and will require positive-pressure ventilation (continued stimulation will not help)
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What is the difference between primary and secondary apnea?
- Perinatal stress results in rapid breathing, which is followed by a period of apnea - during 1ยบ apnea stimulation will resume breathing.
- If cardioresp compromise continues, the baby has more gasping breaths and then secondary apnea
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3 questions to ask yourself when baby is born?
- Term? Breathing or Crying? Good tone? --> if yes to all three, stays on mom
- if no, then continue initial resuscitation steps
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A - Initial steps to establish an airway?
- warmth - towel and skin-to-skin or radiant heater
- position the head to open airway
- dry skin, stimulate to breath and reposition
- No more than 30s total
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A - How to evaluate success of block A?
- If not breathing (apnea or gasping) or HR < 100 - immediate PPV and O2 monitoring
- If laboured or cyanotic breathing - CPAP and O2 monitoring
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B - How to evaluate success?
- If appropriate ventilation - HR should > 100
- If HR < 60 - Block C
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C - circulation - chest - steps?
- If HR < 60 - start chest compressions
- Intubate
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Evaluation of Block C?
If HR < 60 still, despite CPR and ventilation, proceed to block D (drugs)
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D - steps in drugs?
Admin Epi while doing chest comrpessions and ventilation
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What happens when HR rises above 60 again?
stop chest compressions
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When to stop ventilation?
When HR > 100 and baby breathing well
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Antepartum risk factors for needing neonatal resuscitation?
GDM, GHTN or preeclampsia, chronic HTN, fetal anemia or isoimmunization, previous fetal or neonatal death, bleeding in T2/T3, maternal infection, maternal cardiac/renal/pulm/thyroid/neurology disease, polyhydramnios, oligohydramnios, premature rupture of membranes, fetal hydrous, post-term, multiple gestation, size-date discrepancy, drug therapy, adrenergic agonists, maternal substance abuse, fetal malformation or anomalies, diminished fetal activities, no prenatal care, mother older than 35 yrs
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Intrapartum risk factors for needing neonatal resuscitation?
Emergent C-section, Forceps/Vacuum, Breech or AbN presentation, Premature labor, Precipitous labor, Chorioamnionitis, Prolonged rupture of membranes (>18h), Prolonged labour (>24h), macrosomia, category 2/3 fetal heart rate patterns, use of general anesthesia, uterine tachysystole with fetal heart rate changes, narcotic within 4 hrs of delivery, prolapsed cord, meconium in fluid, abruptio placentae, placenta prevue, significant intrapartum bleeding
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Equipment check list - what are the 8 headings for the checklist?
- Warm
- Clear the airway 3 ways
- Auscultate
- Oxygenate
- Ventilate
- Intubate
- Medicate
- Thermoregulate
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Equipment check - warm?
- Warm:
- preheat warmer
- towels or blankets
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Equipment check - Clear Airway
- Bulb syringe
- 10F or 12F suction catheter set at 80-100mmHg
- Meconium aspirator
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APGAR Score - 5 features
- Color - pink
- Heart Rate - > 100
- Reflex irritability - cry or active withdrawal
- Muscle tone - active motion
- Respiration - good/crying
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When to continue APGARs?
- Done at 1 and 5 minutes, but if < 7 at 5 min
- Continue q5min up to 20 min
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